Healthcare Provider Details

I. General information

NPI: 1932245099
Provider Name (Legal Business Name): PUBLIC HEALTH MANAGEMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4108 PARKSIDE AVENUE
PHILADELPHIA PA
19102
US

IV. Provider business mailing address

1500 MARKET ST FL EAST17
PHILADELPHIA PA
19102-2100
US

V. Phone/Fax

Practice location:
  • Phone: 215-871-0300
  • Fax: 215-477-0244
Mailing address:
  • Phone: 215-985-2500
  • Fax: 267-765-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number807285
License Number StatePA

VIII. Authorized Official

Name: MR. RICHARD J COHEN
Title or Position: PRESIDENT
Credential: PHD
Phone: 215-985-2501