=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831725837
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SKY PRESTOWITZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2020
-----------------------------------------------------
Last Update Date | 01/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 861 E ALLEGHENY AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19134-2401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-302-3600
-----------------------------------------------------
Fax | 215-329-2369
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4417 N 6TH ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19140-2319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-302-3600
-----------------------------------------------------
Fax | 215-329-2369
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | OS023722
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | OS023722
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------