Provider Demographics
NPI:1598732117
Name:CENTER FOR OPTIMAL HEALTH LLC
Entity Type:Organization
Organization Name:CENTER FOR OPTIMAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEIKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-239-9901
Mailing Address - Street 1:832 GERMANTOWN AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462
Mailing Address - Country:US
Mailing Address - Phone:610-239-9901
Mailing Address - Fax:610-239-0822
Practice Address - Street 1:832 GERMANTOWN AVENUE
Practice Address - Street 2:SUITE 3
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462
Practice Address - Country:US
Practice Address - Phone:610-239-9901
Practice Address - Fax:610-239-0288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
090353Medicare ID - Type Unspecified