Healthcare Provider Details

I. General information

NPI: 1174620587
Provider Name (Legal Business Name): PIZZICA HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2361 E SUSQUEHANNA AVE
PHILADELPHIA PA
19125-2930
US

IV. Provider business mailing address

100 E LEHIGH AVE
PHILADELPHIA PA
19125-1012
US

V. Phone/Fax

Practice location:
  • Phone: 215-427-3323
  • Fax: 215-427-3321
Mailing address:
  • Phone: 215-707-0159
  • Fax: 215-707-1049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LOUISE T HOLMES
Title or Position: PRACTICE MANAGER
Credential:
Phone: 215-707-1050