Provider Demographics
NPI:1093153785
Name:NORTHWEST MEDICAL & REHABILITATION CENTER PC
Entity Type:Organization
Organization Name:NORTHWEST MEDICAL & REHABILITATION CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-424-1475
Mailing Address - Street 1:6315 STENTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19138
Mailing Address - Country:US
Mailing Address - Phone:215-424-1475
Mailing Address - Fax:215-424-1473
Practice Address - Street 1:6315 STENTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19138
Practice Address - Country:US
Practice Address - Phone:215-424-1475
Practice Address - Fax:215-424-1473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty