EASTERN PENNSYLVANIA PHYSICIAN ALLIANCE LLC


Address: 4641 E Roosevelt Blvd, Philadelphia, PA 19124-2343
Phone: 6103824943

EASTERN PENNSYLVANIA PHYSICIAN ALLIANCE LLC (NPI# 1902440621) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1902440621
Entity Type Organization
Organization Name EASTERN PENNSYLVANIA PHYSICIAN ALLIANCE LLC
Practice Address 4641 E Roosevelt Blvd
Philadelphia
PA 19124-2343
Mailing Address 367 S Gulph Rd
King of Prussia
PA 19406-3121
Practice Telephone 6103824943
Enumeration Date 2019-11-06
Last Update Date 2019-11-06
Authorized Official Name TODD EVANS (VP)
Authorized Official Telephone 6103824943
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 2084P0804X Psychiatry & Neurology
Specialization: Child & Adolescent Psychiatry
Allopathic & Osteopathic Physicians
N 363A00000X Physician Assistant Physician Assistants & Advanced Practice Nursing Providers
N 363L00000X Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers
Y 2084N0400X Psychiatry & Neurology
Specialization: Neurology
Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
PA PENDING 05

Office Location

Street Address 4641 E ROOSEVELT BLVD
City PHILADELPHIA
State PA
Zip Code 19124-2343

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1831749308 William Mark Hanna Sr. Pharmacist 4600 Rooselvelt Blvd Bldg G, Philadelphia, PA 19124 2019-09-17
1881256451 Medical Discovery Systems, LLC Durable Medical Equipment & Medical Supplies 5425 Oxford Ave., 5425 Oxford Ave. Suite (3 A), Philadelphia, PA 19124 2019-07-03
1548731391 Sierra Pinkney Registered Nurse 1615 Granite St, Philadelphia, PA 19124 2018-12-05
1922507987 Xavier Sergio Henriquez Counselor 4510 Frankford Avenue 2nd Floor, Philadelphia, PA 19124 2018-02-06
1558881581 Isabel Cristina Castillo Hernandez Pediatrics 4500-10, Apt 201b, Philadelphia, PA 19124 2017-06-21
1952843732 Patrick Grugan Social Worker Roosevelt Boulevard & Adams Avenue, Philadelphia, PA 19124 2016-11-10
1811340482 Katarzyna Liwski Psychiatry & Neurology 4641 Roosevelt Boulevard, E212, Drexel University College of Medicine Friends Hospital, Philadelphia, PA 19124 2016-07-19
1851769327 Aleka Kostouros Social Worker Roosevelt Blvd & Adams Ave, Northeast Community Center for Behavioral Health, Philadelphia, PA 19124 2015-09-14
1407230378 Sara Bachani Psychiatry & Neurology 4641 Roosevelt Blvd, Friends Hospital, Room 231, Philadelphia, PA 19124 2015-07-10
1215327051 Alyssa Renee Kirk Counselor 4500-10 Frankford Ave, 2nd Floor, Philadelphia, PA 19124 2015-02-02
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Taxonomy Information

Taxonomy Code 2084N0400X
Grouping Allopathic & Osteopathic Physicians
Classification Psychiatry & Neurology
Specialization Neurology

Taxonomy Definition

A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures.
Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1972060176 Ncv Diagnostics LLC Psychiatry & Neurology 1 Brown St Ste C, Philadelphia, PA 19123-3361 2019-02-23
1982102133 Sonia Anand-nichols Md PC Psychiatry & Neurology 5735 Ridge Ave Ste 101, Philadelphia, PA 19128-1746 2018-01-23
1205357886 Kenneth Gross Psychiatry & Neurology 777 S Broad St Apt 412, Philadelphia, PA 19147-2509 2017-07-04
1417339409 Leonel Jorge Favio Estofan Psychiatry & Neurology 245 N 15th St, 7th Floor, Philadelphia, PA 19102-1200 2015-06-25
1073900700 Pavan Anil Vaswani Psychiatry & Neurology 330 S 9th St Fl 3, Philadelphia, PA 19107-6103 2015-04-21
1942613369 Mia Chwan Ko Psychiatry & Neurology 5401 Old York Rd Ste 404, Philadelphia, PA 19141-3046 2014-06-03
1912340415 Simy Kabaria Parikh Psychiatry & Neurology 900 Walnut St Ste 200, Philadelphia, PA 19107-5191 2013-04-15
1215295118 Curtis Brandon Allumbaugh Psychiatry & Neurology 833 Chestnut St Ste 220, Philadelphia, PA 19107 2012-04-27
1013201870 Enrique Aradillas Lopez Psychiatry & Neurology 1200 Constitution Ave Ste 110, Philadelphia, PA 19112-1323 2011-06-08
1598076358 Hristelina S. Ilieva Psychiatry & Neurology 909 Walnut Street 2nd Floor, Philadelphia, PA 19107-3342 2010-06-27
Find all providers in PHILADELPHIA

Competitor

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City PHILADELPHIA
Zip Code 19124

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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