| Northeast Community Center For Mental Health-mental Retardation I | |
|
4641 Roosevelt Blvd Philadelphia PA 19124-2343 | |
| (215) 831-2800 | |
| (215) 831-2929 |
| Full Name | Northeast Community Center For Mental Health-mental Retardation I |
|---|---|
| Speciality | Clinic/Center |
| Location | 4641 Roosevelt Blvd, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | David Como (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2158312800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeast Community Center For Mental Health-mental Retardation I 4641 Roosevelt Blvd Philadelphia PA 19124-2343 Ph: (215) 831-2800 | Northeast Community Center For Mental Health-mental Retardation I 4641 Roosevelt Blvd Philadelphia PA 19124-2343 Ph: (215) 831-2800 |
| NPI Number | 1306907704 |
|---|---|
| Provider Enumeration Date | 12/12/2006 |
| Last Update Date | 07/09/2014 |
| Medicare PECOS PAC ID | 9931195450 |
|---|---|
| Medicare Enrollment ID | O20040421001023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306907704 | NPI | - | NPPES |
| 769146 | Other | PA | MEDICARE PTAN |
| 1000034170051 | Medicaid | PA | |
| 169773 | Other | PA | MEDICARE PTAN |
| Provider Name | Mahrukh S Khan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467426247 PECOS PAC ID: 6901891407 Enrollment ID: I20040415000388 |
| Provider Name | Eliza N Wilfred |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1588748263 PECOS PAC ID: 7719927730 Enrollment ID: I20050510000379 |
| Provider Name | Nasifa Rahman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215074489 PECOS PAC ID: 4587760459 Enrollment ID: I20070509000609 |
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