Basic Information
| Provider Information | |||||||||
| NPI: | 1295499838 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AFFINITY CARE OF PENNSYLVANIA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2302 QUENTIN RD | ||||||||
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| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112292414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6465852175 | ||||||||
| FaxNumber: | 5103806631 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 INTERPLEX DR STE 211 | ||||||||
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| City: | TREVOSE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190536942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104999977 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2021 | ||||||||
| LastUpdateDate: | 12/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | STERN | ||||||||
| AuthorizedOfficialFirstName: | SAMUEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO / OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5104999977 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QH0002X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | 207RH0002X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | 363LA2200X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LF0000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 251G00000X | Y | Agencies | Hospice Care, Community Based |
No ID Information.