Basic Information
| Provider Information | |||||||||
| NPI: | 1720727027 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PENN MEDICAL ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 681 ORANGEBURGH RD | ||||||||
| Address2: | |||||||||
| City: | RIVER VALE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076756404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1516287112 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1608 WALNUT ST. | ||||||||
| Address2: | SUITE 1701A | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191035415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162871120 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2022 | ||||||||
| LastUpdateDate: | 06/03/2022 | ||||||||
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| AuthorizedOfficialLastName: | BARSOUMIAN | ||||||||
| AuthorizedOfficialFirstName: | RAFFI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2158747006 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PENN MEDICAL ASSOCIATES PC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.