Healthcare Provider Details

I. General information

NPI: 1477060598
Provider Name (Legal Business Name): MENA SOLIMAN CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4417 N 6TH ST
PHILADELPHIA PA
19140-2319
US

IV. Provider business mailing address

4417 N 6TH ST
PHILADELPHIA PA
19140-2319
US

V. Phone/Fax

Practice location:
  • Phone: 215-302-3150
  • Fax: 215-329-2000
Mailing address:
  • Phone: 215-302-3150
  • Fax: 215-329-2000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP018379
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number358222
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: