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General NPI Number Information
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NPI Number | 1255464749
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Entity Type | Organization
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Legal Business Name | GREATER NORTHEAST GASTROENTEROLOGY ASSOCIATES PC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 06/07/2018
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Provider Practice Location Address
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Address Line | 7439 FRANKFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19136
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Country | US
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Telephone | 215-333-1377
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Fax | 215-333-1399
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Provider Business Mailing Address
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Address Line | 7439 FRANKFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19136-3600
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Country | US
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Telephone | 215-333-1377
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Fax | 215-333-1399
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALAN MARK MERMELSTEIN
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Credential | MD
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Telephone | 215-634-5595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD033183E
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License Number State | PA
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