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General NPI Number Information
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NPI Number | 1619922580
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Entity Type | Organization
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Legal Business Name | BRANTZ & LIEDMAN ASSOCIATES P.C.
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 02/12/2010
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Provider Practice Location Address
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Address Line | 841 E HUNTING PARK AVE SUITE 110
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City | PHILADELPHIA
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State | PA
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Zip | 19124-4800
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Country | US
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Telephone | 213-535-4494
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Fax | 215-535-4203
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Provider Business Mailing Address
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Address Line | 841 E HUNTING PARK AVE SUITE 110
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City | PHILADELPHIA
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State | PA
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Zip | 19124-4800
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Country | US
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Telephone | 213-535-4494
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Fax | 215-535-4203
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD MICHAEL BRANTZ
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Credential | D.O.
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Telephone | 215-535-4494
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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 | OS003987L
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License Number State | PA
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