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1235 Pine Street Philadelphia PA 19107-5945 | |
| (215) 598-0223 | |
| (215) 598-9020 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1235 Pine Street, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Jason Carroll (BUSINESS MANAGER) |
| Authorized Official Contact | 2157359379 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1235 Pine Street Philadelphia PA 19107-5945 Ph: (215) 598-0223 | 1235 Pine Street Philadelphia PA 19107-5945 Ph: (215) 598-0223 |
| NPI Number | 1780746917 |
|---|---|
| Provider Enumeration Date | 12/14/2006 |
| Last Update Date | 09/10/2015 |
| Medicare PECOS PAC ID | 0446246953 |
|---|---|
| Medicare Enrollment ID | O20040421000980 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780746917 | NPI | - | NPPES |
| 265050000 | Other | PA | MAGELLAN BEHAVIORAL HEALT |
| 000138598 | Other | PA | BCBS |
| 1007279540006 | Medicaid | PA | |
| 0056455000 | Other | PA | BC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 123880 (Pennsylvania) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Muhamad Rifai |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1922053388 PECOS PAC ID: 5597748665 Enrollment ID: I20070713000060 |
| Provider Name | Adnan Zawawi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477538742 PECOS PAC ID: 4385781434 Enrollment ID: I20091022000605 |
| Provider Name | Melissa S Allio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215470679 PECOS PAC ID: 8527349414 Enrollment ID: I20170109001795 |
| Provider Name | Firouzeh Safainili |
|---|---|
| Provider Type | Practitioner - Neuropsychiatry |
| Provider Identifiers | NPI Number: 1194807123 PECOS PAC ID: 5193012177 Enrollment ID: I20180418000052 |
| Provider Name | Lydia K Sit |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619123734 PECOS PAC ID: 4688927767 Enrollment ID: I20181019002442 |
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