=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467333997
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHILADELPHIA HEALTH MANAGEMENT CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2025
-----------------------------------------------------
Last Update Date | 09/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2301 E ALLEGHENY AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19134-4427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-731-2402
-----------------------------------------------------
Fax | 215-985-2550
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 MARKET STREET LM500, LOWER MEZZ, WEST TOWER
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19102-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-985-2500
-----------------------------------------------------
Fax | 215-985-2550
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIR FIN & REG AFFAIRS
-----------------------------------------------------
Name | JAY MILTON WUSSOW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-985-2575
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------