Provider Demographics
NPI:1114035326
Name:ROOSEVELT FAMILY MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:ROOSEVELT FAMILY MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-676-3336
Mailing Address - Street 1:4517 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-1215
Mailing Address - Country:US
Mailing Address - Phone:215-324-1900
Mailing Address - Fax:215-324-4239
Practice Address - Street 1:4517 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-1215
Practice Address - Country:US
Practice Address - Phone:215-324-1900
Practice Address - Fax:215-324-4239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0058484001Other10 DIGIT HMO ID