| Brantz & Liedman Associates P.c. | |
|
841 E Hunting Park Ave Suite 110 Philadelphia PA 19124-4800 | |
| (213) 535-4494 | |
| (215) 535-4203 |
| Full Name | Brantz & Liedman Associates P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 841 E Hunting Park Ave, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Richard Michael Brantz (PRESIDENT) |
| Authorized Official Contact | 2155354494 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brantz & Liedman Associates P.c. 841 E Hunting Park Ave Suite 110 Philadelphia PA 19124-4800 Ph: (213) 535-4494 | Brantz & Liedman Associates P.c. 841 E Hunting Park Ave Suite 110 Philadelphia PA 19124-4800 Ph: (213) 535-4494 |
| NPI Number | 1619922580 |
|---|---|
| Provider Enumeration Date | 05/22/2006 |
| Last Update Date | 02/12/2010 |
| Medicare PECOS PAC ID | 9739168576 |
|---|---|
| Medicare Enrollment ID | O20040715001119 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619922580 | NPI | - | NPPES |
| 00712055 | Medicaid | PA | |
| 07512394 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | OS003987L (Pennsylvania) | Primary |
| Provider Name | Sarwat Jahan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770707473 PECOS PAC ID: 9931012424 Enrollment ID: I20031111000137 |
| Provider Name | Henry C Quevedo Diaz |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1679708374 PECOS PAC ID: 8325337686 Enrollment ID: I20190930000068 |
| Provider Name | Deepali Mathur |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497308753 PECOS PAC ID: 5597191965 Enrollment ID: I20200203001154 |
| Provider Name | Kumba G Komba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639738610 PECOS PAC ID: 7214368018 Enrollment ID: I20200512000149 |
| Provider Name | Emily Scaruzzi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225644107 PECOS PAC ID: 5496165052 Enrollment ID: I20201110002444 |
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