Healthcare Provider Details

I. General information

NPI: 1669410387
Provider Name (Legal Business Name): SENIOR HEALTH ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7604 CENTRAL AVE
PHILADELPHIA PA
19111-2433
US

IV. Provider business mailing address

7604 CENTRAL AVE
PHILADELPHIA PA
19111-2433
US

V. Phone/Fax

Practice location:
  • Phone: 215-742-2100
  • Fax:
Mailing address:
  • Phone: 215-742-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number101301
License Number StatePA

VIII. Authorized Official

Name: MR. GERALD P OETZEL
Title or Position: CFO
Credential:
Phone: 215-728-3306