Provider Demographics
NPI:1598719627
Name:NINTH STREET INTERNAL MEDICINE ASSOCIATES LTD
Entity Type:Organization
Organization Name:NINTH STREET INTERNAL MEDICINE ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TESTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-440-8681
Mailing Address - Street 1:805 LOCUST STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5507
Mailing Address - Country:US
Mailing Address - Phone:215-440-8681
Mailing Address - Fax:215-440-9953
Practice Address - Street 1:805 LOCUST STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5507
Practice Address - Country:US
Practice Address - Phone:215-440-8681
Practice Address - Fax:215-440-9953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA544084JFKMedicare ID - Type Unspecified