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General NPI Number Information
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NPI Number | 1609936947
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Entity Type | Organization
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Legal Business Name | HENRY AVE PHCY
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Dates
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Enumeration Date | 12/09/2006
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 5830 HENRY AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19128-1701
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Country | US
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Telephone | 215-483-3300
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Fax | 215-483-5471
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Provider Business Mailing Address
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Address Line | 5830 HENRY AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19128-1701
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Country | US
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Telephone | 215-483-3300
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Fax | 215-483-5471
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL SADEL
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Credential |
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Telephone | 215-483-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PP-415575-L
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License Number State | PA
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