Provider Demographics
NPI:1225483332
Name:SOUTHAMPTON PATIENT COORDINATION LLC
Entity Type:Organization
Organization Name:SOUTHAMPTON PATIENT COORDINATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YEFIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GORBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-538-8610
Mailing Address - Street 1:122 STEPHENSON WAY
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-2229
Mailing Address - Country:US
Mailing Address - Phone:267-538-8610
Mailing Address - Fax:
Practice Address - Street 1:1018 STREET RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4221
Practice Address - Country:US
Practice Address - Phone:267-538-8610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health