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NPI Code Detail

MEDICARE: NE PHYSICIAN SERVICES INC

MEDICARE: NE PHYSICIAN SERVICES INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10097905013OTHERPAINDEPENDENCE BLUE CROSS

General Provider Information

NPI Number : 1043487473
Entity Type Code : Organization
Provider Name (Legal Business Name) : NE PHYSICIAN SERVICES INC
Provider Business Mailing Address
First Line : 3542 WELSH RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19136-2623
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10400 ROOSEVELT BLVD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19116-3905
Country : US
Telephone Number : 215-333-6888
Fax Number :
Authorized Official
Title or Position : OFFICE ADMINISTRATOR
Name : DIANE DEPMAN
Credential :
Telephone Number : 215-333-6888
Provider Enumeration Date : 05/14/2008
Last Update Date : 05/14/2008

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Directions to “NE PHYSICIAN SERVICES INC ” Practice Location

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