Provider Demographics
NPI:1821503038
Name:PHILLY NEWLIFE SUBOXONE CLINICS
Entity Type:Organization
Organization Name:PHILLY NEWLIFE SUBOXONE CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-966-8666
Mailing Address - Street 1:3477 SAINT VINCENT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1628
Mailing Address - Country:US
Mailing Address - Phone:215-966-8666
Mailing Address - Fax:215-780-1779
Practice Address - Street 1:3477 SAINT VINCENT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1628
Practice Address - Country:US
Practice Address - Phone:215-966-8666
Practice Address - Fax:215-780-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-11
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty