Healthcare Provider Details

I. General information

NPI: 1982657987
Provider Name (Legal Business Name): ASOCIACION PUERTORRIQUENOS EN MARCHA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2147 N 6TH ST
PHILADELPHIA PA
19122-1415
US

IV. Provider business mailing address

4301 RISING SUN AVENUE
PHILADELPHIA PA
19140
US

V. Phone/Fax

Practice location:
  • Phone: 215-235-7555
  • Fax: 215-769-7025
Mailing address:
  • Phone: 267-972-7200
  • Fax: 215-455-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number134920
License Number StatePA

VIII. Authorized Official

Name: DR. ROGER ERRO
Title or Position: MEDICAL DIRECTOR PSYCHIATRIST
Credential: M.D.
Phone: 215-235-6788