Healthcare Provider Details

I. General information

NPI: 1649616798
Provider Name (Legal Business Name): GENESIS PENNYPACK CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8015 LAWNDALE AVE
PHILADELPHIA PA
19111-1507
US

IV. Provider business mailing address

8015 LAWNDALE STREET
PHILADELPHIA PA
19111-1507
US

V. Phone/Fax

Practice location:
  • Phone: 215-725-2525
  • Fax: 215-745-3970
Mailing address:
  • Phone: 215-725-2525
  • Fax: 215-745-3970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberOS001737L
License Number StatePA

VIII. Authorized Official

Name: DR. EDWIN MEROW
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 215-725-2525