Provider Demographics
NPI:1154470862
Name:HARESH & PRIYA PUNJABI MDPC
Entity Type:Organization
Organization Name:HARESH & PRIYA PUNJABI MDPC
Other - Org Name:HARESH & PRIYA PUNJABI MDPC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PRIYA
Authorized Official - Middle Name:H
Authorized Official - Last Name:PUNJABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-427-3343
Mailing Address - Street 1:689 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-2221
Mailing Address - Country:US
Mailing Address - Phone:215-427-3343
Mailing Address - Fax:215-322-4553
Practice Address - Street 1:2250 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134
Practice Address - Country:US
Practice Address - Phone:215-427-3343
Practice Address - Fax:215-427-0533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038932L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00839466-02Medicaid
PA00839635-02Medicaid
PA00839466-02Medicaid