Provider Demographics
NPI:1043263726
Name:ROOSEVELT EMERGENCY PHYSICIANS
Entity Type:Organization
Organization Name:ROOSEVELT EMERGENCY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:P
Authorized Official - Last Name:STANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-335-6150
Mailing Address - Street 1:100 WITMER RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2211
Mailing Address - Country:US
Mailing Address - Phone:215-442-5051
Mailing Address - Fax:215-957-2875
Practice Address - Street 1:2601 HOLMES AVEUNE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152
Practice Address - Country:US
Practice Address - Phone:215-335-6150
Practice Address - Fax:215-335-1832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019172260001Medicaid
PA=========OtherTRICARE
PA063045Medicare PIN
PACK9321Medicare PIN