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General NPI Number Information
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NPI Number | 1013389477
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Entity Type | Organization
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Legal Business Name | EASTER GAU LLC
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Dates
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Enumeration Date | 10/26/2015
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Last Update Date | 10/26/2015
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Provider Practice Location Address
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Address Line | 309 S 43RD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4017
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Country | US
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Telephone | 267-516-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 1202 STOTESBURY AVE
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City | WYNDMOOR
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State | PA
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Zip | 19038-7440
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Country | US
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Telephone | 215-882-1442
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EASTER GAU
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Credential | MS
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Telephone | 215-882-1442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PC007932
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License Number State | PA
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