Basic Information
| Provider Information | |||||||||
| NPI: | 1437190238 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR SAMUEL LIZERBRAM & DR NEIL M COHEN PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12000 BUSTLETON AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191162151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156737600 | ||||||||
| FaxNumber: | 2156731894 | ||||||||
| Practice Location | |||||||||
| Address1: | 12000 BUSTLETON AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191162151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156737600 | ||||||||
| FaxNumber: | 2156731894 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 08/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | LIZERBRAM | ||||||||
| AuthorizedOfficialFirstName: | SAMUEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2156737600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS002814L | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00006962380001 | 05 | PA | MEDICAID |