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General NPI Number Information
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NPI Number | 1225430572
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Entity Type | Organization
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Legal Business Name | ERFPRAD II, LLC
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Dates
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Enumeration Date | 09/18/2014
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 525 JAMESTOWN ST STE 107
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City | PHILADELPHIA
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State | PA
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Zip | 19128-1751
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Country | US
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Telephone | 215-205-2260
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Fax | 877-203-4832
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Provider Business Mailing Address
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Address Line | 525 JAMESTOWN ST STE 107
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City | PHILADELPHIA
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State | PA
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Zip | 19128-1751
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Country | US
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Telephone | 215-205-2260
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Fax | 877-203-4832
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Authorized Official
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Title or Position | OWNER
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Name | DR. WARREN MARK COHEN
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Credential | DO
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Telephone | 215-205-2260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | O8003968L
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License Number State | PA
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