Healthcare Provider Details

I. General information

NPI: 1750615126
Provider Name (Legal Business Name): ALLIANCE HEALTHCARE SYSTEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9924 E. ROOSEVELT BLVD.
PHILADELPHIA PA
19115
US

IV. Provider business mailing address

9924 E. ROOSEVELT BLVD.
PHILADELPHIA PA
19115
US

V. Phone/Fax

Practice location:
  • Phone: 215-673-9260
  • Fax:
Mailing address:
  • Phone: 215-673-9260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAOUL BINIAURISHVILI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 215-673-9260