MEDICARE: OLD YORK HEALTH CLINIC 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
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1275773095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLD YORK HEALTH CLINIC INC

Provider Business Mailing Address
First Line	:	6901 OLD YORK RD
Second Line	:	SUITE A101
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-2234
Country	:	US
Telephone Number	:	215-224-0400
Fax Number	:	215-224-0445

Provider Business Practice Location Address
First Line	:	6901 OLD YORK RD
Second Line	:	SUITE A101
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-2234
Country	:	US
Telephone Number	:	215-224-0400
Fax Number	:	215-224-0445

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ASHOT NAGAPETIAN
Credential	:
Telephone Number	:	215-224-0400

Provider Enumeration Date	:	03/06/2009
Last Update Date	:	03/06/2009

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Directions to “OLD YORK HEALTH CLINIC INC ” Practice Location

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