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General NPI Number Information
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NPI Number | 1669410387
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Entity Type | Organization
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Legal Business Name | SENIOR HEALTH ASSOCIATES
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7604 CENTRAL AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19111-2433
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Country | US
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Telephone | 215-742-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 7604 CENTRAL AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19111-2433
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Country | US
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Telephone | 215-742-2100
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. GERALD P OETZEL
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Credential |
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Telephone | 215-728-3306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 101301
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License Number State | PA
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