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General NPI Number Information
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NPI Number | 1851332589
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Entity Type | Organization
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Legal Business Name | PASSYUNK MEDICAL ASSOCIATES PC
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 03/22/2018
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Provider Practice Location Address
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Address Line | 1626 E PASSYUNK AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19148-1122
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Country | US
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Telephone | 215-467-0700
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Fax | 215-467-4457
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Provider Business Mailing Address
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Address Line | 1626 E PASSYUNK AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19148-1122
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Country | US
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Telephone | 215-467-0700
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Fax | 215-467-4457
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Authorized Official
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Title or Position | DOCTOR
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Name | MICHAEL PISANO
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Credential | DO
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Telephone | 215-467-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS007441L
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License Number State | PA
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