Provider Demographics
NPI:1467494567
Name:NORTHEASTERN CARDIOLOGY ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:NORTHEASTERN CARDIOLOGY ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-329-0633
Mailing Address - Street 1:5401 OLD YORK RD
Mailing Address - Street 2:KLEIN BUILDING, SUITE 401
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3046
Mailing Address - Country:US
Mailing Address - Phone:215-329-0633
Mailing Address - Fax:215-329-6678
Practice Address - Street 1:2301 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4427
Practice Address - Country:US
Practice Address - Phone:215-329-0633
Practice Address - Fax:215-329-6678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011354450005Medicaid
PA0011354450005Medicaid