Provider Demographics
NPI:1437662814
Name:EMPIRICAL PEDIATRIC THERAPY, INC.
Entity Type:Organization
Organization Name:EMPIRICAL PEDIATRIC THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAISEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STANGO
Authorized Official - Suffix:
Authorized Official - Credentials:JD, MBA
Authorized Official - Phone:267-908-7772
Mailing Address - Street 1:702 N 3RD ST PMB 854
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123
Mailing Address - Country:US
Mailing Address - Phone:267-908-7772
Mailing Address - Fax:
Practice Address - Street 1:413 FAIRMOUNT AVE # 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-2807
Practice Address - Country:US
Practice Address - Phone:267-908-7772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002146103K00000X
PAOC010741225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty