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NPI Code Detail

MEDICARE: FRANKFORD AVENUE FAMILY PRACTICE, P.C.

MEDICARE: FRANKFORD AVENUE FAMILY PRACTICE, P.C.
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
1332900000XNon-Pharmacy Dispensing SiteMD045687LPA

General Provider Information

NPI Number : 1124160775
Entity Type Code : Organization
Provider Name (Legal Business Name) : FRANKFORD AVENUE FAMILY PRACTICE, P.C.
Provider Business Mailing Address
First Line : 5626 OBERLIN DR
Second Line : SUITE110
City : SAN DIEGO
State : CA
Zip : 92121-1705
Country : US
Telephone Number : 858-625-2990
Fax Number :
Provider Business Practice Location Address
First Line : 8846 FRANKFORD AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19136-1313
Country : US
Telephone Number : 215-332-8221
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF OPERATIONS
Name : KENNY HEINE
Credential :
Telephone Number : 858-625-2990
Provider Enumeration Date : 02/12/2007
Last Update Date : 10/16/2012

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Directions to “FRANKFORD AVENUE FAMILY PRACTICE, P.C. ” Practice Location

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