Provider Demographics
NPI:1093770216
Name:NORTHEAST MEDICAL PRACTICE, LIMITED
Entity type:Organization
Organization Name:NORTHEAST MEDICAL PRACTICE, LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:NESBITT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-291-3107
Mailing Address - Street 1:2301 E ALLEGHENY AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4427
Mailing Address - Country:US
Mailing Address - Phone:215-291-3107
Mailing Address - Fax:215-291-3112
Practice Address - Street 1:2301 E ALLEGHENY AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4427
Practice Address - Country:US
Practice Address - Phone:215-291-3107
Practice Address - Fax:215-291-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
149285Medicare ID - Type Unspecified