Provider Demographics
NPI:1386883239
Name:AMERICAN EXPRESS LOAN INC
Entity type:Organization
Organization Name:AMERICAN EXPRESS LOAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:F
Authorized Official - Last Name:AVAGIMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-677-8999
Mailing Address - Street 1:13420 DAMAR DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-1816
Mailing Address - Country:US
Mailing Address - Phone:215-677-8999
Mailing Address - Fax:
Practice Address - Street 1:13420 DAMAR DR
Practice Address - Street 2:SUITE C
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-1816
Practice Address - Country:US
Practice Address - Phone:215-677-8999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2011-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance