Provider Demographics
NPI:1437190238
Name:DR SAMUEL LIZERBRAM & DR NEIL M COHEN PC
Entity Type:Organization
Organization Name:DR SAMUEL LIZERBRAM & DR NEIL M COHEN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LIZERBRAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-673-7600
Mailing Address - Street 1:12000 BUSTLETON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-2151
Mailing Address - Country:US
Mailing Address - Phone:215-673-7600
Mailing Address - Fax:215-673-1894
Practice Address - Street 1:12000 BUSTLETON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-2151
Practice Address - Country:US
Practice Address - Phone:215-673-7600
Practice Address - Fax:215-673-1894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002814L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00006962380001Medicaid
PWD77423Medicare UPIN
PA00006962380001Medicaid