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General NPI Number Information
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NPI Number | 1164663050
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Entity Type | Organization
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Legal Business Name | RITTENHOUSE PLASTIC SURGERY, P.C.
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Dates
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Enumeration Date | 03/23/2009
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Last Update Date | 03/23/2009
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Provider Practice Location Address
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Address Line | 255 S 17TH ST STE 2200 MEDICAL TOWER BUILDING
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City | PHILADELPHIA
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State | PA
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Zip | 19103-6221
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Country | US
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Telephone | 215-732-3340
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Fax | 215-732-3160
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Provider Business Mailing Address
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Address Line | 255 S 17TH ST STE 2200 MEDICAL TOWER BUILDING
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City | PHILADELPHIA
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State | PA
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Zip | 19103-6221
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Country | US
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Telephone | 215-732-3340
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Fax | 215-732-3160
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Authorized Official
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Title or Position | CEO
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Name | DR. ALGIRD RAYMOND MAMENISKIS
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Credential | M.D.
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Telephone | 215-732-3340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD041644E
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License Number State | PA
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