Provider Demographics
NPI:1235679044
Name:NORMAN MUDASIR DC PC
Entity Type:Organization
Organization Name:NORMAN MUDASIR DC PC
Other - Org Name:PROHEALTH MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUDASIR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-424-4005
Mailing Address - Street 1:6000 N BROAD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-1900
Mailing Address - Country:US
Mailing Address - Phone:215-424-4005
Mailing Address - Fax:
Practice Address - Street 1:6000 N BROAD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-1900
Practice Address - Country:US
Practice Address - Phone:215-424-4005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009174261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation