Healthcare Provider Details

I. General information

NPI: 1841852241
Provider Name (Legal Business Name): CIL INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3508 MARKET ST STE 256
PHILADELPHIA PA
19104-3320
US

IV. Provider business mailing address

3508 MARKET ST STE 256
PHILADELPHIA PA
19104-3320
US

V. Phone/Fax

Practice location:
  • Phone: 215-921-5508
  • Fax: 215-627-1999
Mailing address:
  • Phone: 215-921-5508
  • Fax: 214-627-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD VICTOR EIDELSON
Title or Position: PRESIDENT
Credential: DDS
Phone: 215-921-5508