Provider Demographics
NPI:1922179464
Name:ACADEMY PHYSICAL MEDICINE, P.C.
Entity Type:Organization
Organization Name:ACADEMY PHYSICAL MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HARLAN
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-333-9999
Mailing Address - Street 1:9140 ACADEMY RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2853
Mailing Address - Country:US
Mailing Address - Phone:215-333-9999
Mailing Address - Fax:215-333-9815
Practice Address - Street 1:9140 ACADEMY RD
Practice Address - Street 2:SUITE K
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2853
Practice Address - Country:US
Practice Address - Phone:215-333-9999
Practice Address - Fax:215-333-9815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003542L111N00000X
PAAK000175L171100000X
PAMD015564E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Not Answered174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA84161Medicare ID - Type Unspecified
PAC29335Medicare UPIN