=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942254511
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY NEUROSURGICAL, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2630 HOLME AVE SUITE 103
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19152-3009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-331-0126
-----------------------------------------------------
Fax | 215-331-0520
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2630 HOLME AVE SUITE 103
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19152-3009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-331-0126
-----------------------------------------------------
Fax | 215-331-0520
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SAEID ALEMO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 215-331-0126
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204C00000X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
-----------------------------------------------------
License Number | MD037547L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------