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205 N Broad St Suite 100 Philadelphia PA 19107-1554 | |
| (215) 587-8008 | |
| (215) 587-6248 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 205 N Broad St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | David Janiec (DIRECTOR OF PAYER CONTRACTING) |
| Authorized Official Contact | 2152557766 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1601 Cherry St Suite 11511 Philadelphia PA 19102-1321 Ph: (215) 255-7822 | 205 N Broad St Suite 100 Philadelphia PA 19107-1554 Ph: (215) 587-8008 |
| NPI Number | 1861725194 |
|---|---|
| Provider Enumeration Date | 09/18/2009 |
| Last Update Date | 01/25/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861725194 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Pennsylvania) | Primary |
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