Provider Demographics
NPI:1194361980
Name:PUBLIC HEALTH MANAGMENT CORPORATION (PHMC)
Entity Type:Organization
Organization Name:PUBLIC HEALTH MANAGMENT CORPORATION (PHMC)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF FINANCE & REGULATORY AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:WUSSOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-985-2575
Mailing Address - Street 1:1500 MARKET STREET
Mailing Address - Street 2:LM500, LOWER MEZZANINE, WEST TOWER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2110
Mailing Address - Country:US
Mailing Address - Phone:215-985-2500
Mailing Address - Fax:215-985-2550
Practice Address - Street 1:2301 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4427
Practice Address - Country:US
Practice Address - Phone:215-731-2402
Practice Address - Fax:267-592-4123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health