Provider Demographics
NPI:1619922580
Name:BRANTZ & LIEDMAN ASSOCIATES P.C.
Entity Type:Organization
Organization Name:BRANTZ & LIEDMAN ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BRANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-535-4494
Mailing Address - Street 1:841 E HUNTING PARK AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-4800
Mailing Address - Country:US
Mailing Address - Phone:213-535-4494
Mailing Address - Fax:215-535-4203
Practice Address - Street 1:841 E HUNTING PARK AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-4800
Practice Address - Country:US
Practice Address - Phone:213-535-4494
Practice Address - Fax:215-535-4203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003987L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00712055Medicaid
PA07512394Medicaid
PA173358Medicare ID - Type Unspecified
D98753Medicare UPIN
PAD98681Medicare UPIN