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General NPI Number Information
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NPI Number | 1700070687
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Entity Type | Organization
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Legal Business Name | NORTHEAST MEDICAL AND REHABILITATION CENTER, P.C.
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 14200 BUSTLETON AVE STE 4
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City | PHILADELPHIA
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State | PA
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Zip | 19116-1186
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Country | US
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Telephone | 215-671-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 14200 BUSTLETON AVE STE 4
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City | PHILADELPHIA
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State | PA
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Zip | 19116-1186
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Country | US
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Telephone | 215-671-0900
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DEBORAH GARBER LIZERBRAM
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Credential | D.O.
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Telephone | 215-671-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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