Provider Demographics
NPI:1225687593
Name:NELSON, IBN-HANEEF SAKIN
Entity Type:Individual
Prefix:
First Name:IBN-HANEEF SAKIN
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 CHESTNUT ST UNIT 11702
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-0002
Mailing Address - Country:US
Mailing Address - Phone:610-492-5696
Mailing Address - Fax:610-492-5620
Practice Address - Street 1:528 HAMPDEN RD
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-5021
Practice Address - Country:US
Practice Address - Phone:610-492-5696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA44573601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health