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General NPI Number Information
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NPI Number | 1174349724
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Entity Type | Organization
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Legal Business Name | FIRST BRICK CLINIC
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Dates
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Enumeration Date | 11/27/2024
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 2757 N 5TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19133-2700
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Country | US
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Telephone | 215-839-9661
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Fax |
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Provider Business Mailing Address
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Address Line | 4017 INDIAN GUIDE RD
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City | LAFAYETTE HILL
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State | PA
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Zip | 19444-1308
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SYMANTHA HOWER
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Credential |
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Telephone | 267-421-8193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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