Provider Demographics
NPI:1639126147
Name:ASSOCIATED FAMILY PRACTICE PROFESSIONALS, P.C.
Entity Type:Organization
Organization Name:ASSOCIATED FAMILY PRACTICE PROFESSIONALS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-355-9065
Mailing Address - Street 1:9821 ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1545
Mailing Address - Country:US
Mailing Address - Phone:215-632-8700
Mailing Address - Fax:215-632-5901
Practice Address - Street 1:1404 BROWNSVILLE RD
Practice Address - Street 2:
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-4668
Practice Address - Country:US
Practice Address - Phone:215-364-1500
Practice Address - Fax:215-364-5140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
025726Medicare ID - Type Unspecified