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General NPI Number Information
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NPI Number | 1104690379
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Entity Type | Organization
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Legal Business Name | FORT HEALTH MEDICAL GROUP PA
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Dates
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Enumeration Date | 11/08/2023
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 100 S JUNIPER ST FL 3
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City | PHILADELPHIA
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State | PA
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Zip | 19107-1316
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Country | US
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Telephone | 201-208-2616
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Fax |
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Provider Business Mailing Address
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Address Line | 1887 WHITNEY MESA DR # 9001ZN
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City | HENDERSON
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State | NV
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Zip | 89014-2069
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Country | US
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Telephone | 201-208-2616
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Fax | 973-381-5773
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SABA HAQ
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Credential | MD
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Telephone | 949-463-0650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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