Provider Demographics
NPI:1710324397
Name:HURWITZ, EMILY (DO)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:HURWITZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W LEHIGH AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19133-1640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1991 SPROUL ROAD SUITE 300
Practice Address - Street 2:
Practice Address - City:BROOMALL PA
Practice Address - State:PA
Practice Address - Zip Code:19008
Practice Address - Country:US
Practice Address - Phone:610-325-1390
Practice Address - Fax:610-325-1373
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT015153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103220350-0001Medicaid
PA103220350-0001Medicaid