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2921 N 5th St Philadelphia PA 19133-2800 | |
| (215) 259-3373 | |
| (267) 329-9728 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2921 N 5th St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Nilda Ruiz (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2672967200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4301 Rising Sun Ave Philadelphia PA 19140-2719 Ph: (267) 296-7220 | 2921 N 5th St Philadelphia PA 19133-2800 Ph: (215) 259-3373 |
| NPI Number | 1003093121 |
|---|---|
| Provider Enumeration Date | 01/31/2008 |
| Last Update Date | 07/08/2024 |
| Certification Date | 07/08/2024 |
| Medicare PECOS PAC ID | 7214919877 |
|---|---|
| Medicare Enrollment ID | O20040607000439 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003093121 | NPI | - | NPPES |
| 1003114240021 | Medicaid | PA | |
| 1003093121 | Medicaid | PA |
| Provider Name | Hector Colon Rivera |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508132119 PECOS PAC ID: 4183848849 Enrollment ID: I20190514000225 |
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