| |
8200 Henry Ave Suite G 1 Philadelphia PA 19128-2984 | |
(215) 482-2336 | |
(215) 483-4339 |
Full Name | |
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Speciality | Internal Medicine |
Location | 8200 Henry Ave, Philadelphia, Pennsylvania |
Authorized Official Name and Position | Lawrence Jay Kessel (PRESIDENT) |
Authorized Official Contact | 2154822336 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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8200 Henry Ave Suite G 1 Philadelphia PA 19128-2984 Ph: (215) 482-2336 | 8200 Henry Ave Suite G 1 Philadelphia PA 19128-2984 Ph: (215) 482-2336 |
NPI Number | 1922009646 |
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Provider Enumeration Date | 08/03/2005 |
Last Update Date | 07/21/2022 |
Medicare PECOS PAC ID | 8022096916 |
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Medicare Enrollment ID | O20040708000452 |
Identifier | Type | State | Issuer |
---|---|---|---|
1922009646 | NPI | - | NPPES |
1007749810004 | Medicaid | PA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (Pennsylvania) | Primary |
Provider Name | Lawrence J Kessel |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1467452581 PECOS PAC ID: 6800890443 Enrollment ID: I20110202000739 |
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