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General NPI Number Information
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NPI Number | 1841475225
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Entity Type | Organization
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Legal Business Name | AHI SKIN REJUVENATION CENTER
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Dates
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Enumeration Date | 01/04/2008
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Last Update Date | 08/17/2010
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Provider Practice Location Address
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Address Line | 415 BUSINESS PARK LN
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City | ALLENTOWN
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State | PA
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Zip | 18109-9120
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Country | US
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Telephone | 267-319-1530
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Fax | 267-319-1531
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Provider Business Mailing Address
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Address Line | 1233 LOCUST STREET SUITE 304
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City | PHILADELPHIA
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State | PA
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Zip | 19107
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Country | US
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Telephone | 267-319-1530
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Fax | 267-319-1531
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Authorized Official
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Title or Position | DIRECTOR OF NURSING
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Name | MR. PATRICK ROBERT STONICH
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Credential | RN,BSN
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Telephone | 267-319-1530
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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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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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