MEDICARE: ASOCIACION PUERTORRIQUENOS EN MARCHA

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	134920	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982657987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASOCIACION PUERTORRIQUENOS EN MARCHA

Provider Business Mailing Address
First Line	:	4301 RISING SUN AVENUE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140
Country	:	US
Telephone Number	:	267-972-7200
Fax Number	:	215-455-6501

Provider Business Practice Location Address
First Line	:	2147 N 6TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-1415
Country	:	US
Telephone Number	:	215-235-7555
Fax Number	:	215-769-7025

Authorized Official
Title or Position	:	MEDICAL DIRECTOR PSYCHIATRIST
Name	:	DR. ROGER ERRO
Credential	:	M.D.
Telephone Number	:	215-235-6788

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	02/20/2008

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