Healthcare Provider Details

I. General information

NPI: 1992171508
Provider Name (Legal Business Name): STO-ROX NEIGHBORHOOD HEALTH COUNCIL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 LOCUST ST
PITTSBURGH PA
15219-5131
US

IV. Provider business mailing address

1515 LOCUST ST
PITTSBURGH PA
15219-5131
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax: 999-999-9999
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REGIS J. RYAN
Title or Position: EXECUTIVE DIRECTOR/CEO
Credential:
Phone: 412-771-6462