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General NPI Number Information
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NPI Number | 1306262456
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Entity Type | Organization
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Legal Business Name | LAND MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/13/2014
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 4 NESHAMINY INTERPLEX DR STE 101
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City | FEASTERVILLE TREVOSE
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State | PA
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Zip | 19053-6940
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Country | US
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Telephone | 215-294-6790
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Fax | 215-474-4418
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Provider Business Mailing Address
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Address Line | 4 NESHAMINY INTERPLEX DR STE 101
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City | FEASTERVILLE TREVOSE
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State | PA
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Zip | 19053-6940
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Country | US
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Telephone | 215-294-6790
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Fax | 215-474-4418
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Authorized Official
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Title or Position | CHAIRMAN/CEO
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Name | DR. HENRY I BALOGUN
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Credential | PH.D
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Telephone | 215-294-6790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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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 | 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 #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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