Healthcare Provider Details

I. General information

NPI: 1346357399
Provider Name (Legal Business Name): 7622 MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7622 OGONTZ AVE
PHILADELPHIA PA
19150-1817
US

IV. Provider business mailing address

7622 OGONTZ AVE
PHILADELPHIA PA
19150-1817
US

V. Phone/Fax

Practice location:
  • Phone: 215-893-4700
  • Fax: 215-893-4704
Mailing address:
  • Phone: 215-893-4700
  • Fax: 215-893-4704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY LINCOW
Title or Position: V.P. OF OPERATIONS
Credential:
Phone: 215-893-4700