| Full Name | |
|---|---|
| Speciality | Pediatrics |
| Location | 160 E Erie Avenue, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Robert Ehinger (SR VP FINANCIAL OPERATIONS) |
| Authorized Official Contact | 4846284681 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 13579 Reading PA 19612-3579 Ph: (610) 743-6049 | 160 E Erie Avenue Philadelphia PA 19134-1000 Ph: () - |
| NPI Number | 1972147304 |
|---|---|
| Provider Enumeration Date | 10/29/2019 |
| Last Update Date | 05/11/2022 |
| Certification Date | 05/11/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972147304 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | (* (Not Available)) | Primary |
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