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2000 Grant Ave Ste 201 Philadelphia PA 19115-4378 | |
| (215) 464-6104 | |
| (215) 464-9104 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2000 Grant Ave Ste 201, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Zoya Berenson (PRESIDENT) |
| Authorized Official Contact | 2154646104 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2000 Grant Ave Ste 201 Philadelphia PA 19115-4378 Ph: (215) 464-6104 | 2000 Grant Ave Ste 201 Philadelphia PA 19115-4378 Ph: (215) 464-6104 |
| NPI Number | 1407897903 |
|---|---|
| Provider Enumeration Date | 06/08/2006 |
| Last Update Date | 03/24/2023 |
| Medicare PECOS PAC ID | 6709858012 |
|---|---|
| Medicare Enrollment ID | O20040809000135 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407897903 | NPI | - | NPPES |
| 0017423170002 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | John P Leichner |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1225072192 PECOS PAC ID: 2567414832 Enrollment ID: I20050215000417 |
| Provider Name | Ira J Silverman |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1588600936 PECOS PAC ID: 1759313083 Enrollment ID: I20050912000462 |
| Provider Name | Zoya Berenson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457392862 PECOS PAC ID: 3173587177 Enrollment ID: I20100311000631 |
| Provider Name | Robert S Auerbach |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1861478034 PECOS PAC ID: 2264560176 Enrollment ID: I20100514000047 |
| Provider Name | Richard Lawrence Lizerbram |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1619055019 PECOS PAC ID: 1153444500 Enrollment ID: I20110602000277 |
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