Provider Demographics
NPI:1205656394
Name:PHILADELPHIA HEALTH AND WELLNESS,LLC.
Entity type:Organization
Organization Name:PHILADELPHIA HEALTH AND WELLNESS,LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:106-999-8210
Mailing Address - Street 1:220 WILMINGTON W CHESTER PIKE STE 5
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9078
Mailing Address - Country:US
Mailing Address - Phone:610-507-2556
Mailing Address - Fax:
Practice Address - Street 1:220 WILMINGTON W CHESTER PIKE STE 5
Practice Address - Street 2:
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-9078
Practice Address - Country:US
Practice Address - Phone:610-507-2556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-14
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty