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9622 Bustleton Avenue Suite 2 Philadelphia PA 19115 | |
| (215) 947-6143 | |
| (215) 947-6274 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 9622 Bustleton Avenue, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Andrew Mark Berkowitz (PRESIDENT) |
| Authorized Official Contact | 2159476143 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
725 Lisa Circle Huntingdon Valley PA 19006-2223 Ph: (215) 947-6143 | 9622 Bustleton Avenue Suite 2 Philadelphia PA 19115 Ph: (215) 947-6143 |
| NPI Number | 1508912007 |
|---|---|
| Provider Enumeration Date | 01/26/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508912007 | NPI | - | NPPES |
| 0011215100001 | Medicaid | PA | |
| 0486513000 | Other | PA | PERSONAL CHOICE |
| 0486513001 | Other | PA | BLUE SHIELD HIGHMARK KEY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MD036462E (Pennsylvania) | Primary |
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