Provider Demographics
NPI:1922188788
Name:ALBERT MEDICAL CENTER CORPORATION
Entity Type:Organization
Organization Name:ALBERT MEDICAL CENTER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HEE
Authorized Official - Middle Name:G
Authorized Official - Last Name:PAE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:215-635-1160
Mailing Address - Street 1:1400 WILLOW AVE STE B1
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-3100
Mailing Address - Country:US
Mailing Address - Phone:215-635-1160
Mailing Address - Fax:215-635-1733
Practice Address - Street 1:1400 WILLOW AVE STE B1
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3100
Practice Address - Country:US
Practice Address - Phone:215-635-1160
Practice Address - Fax:215-635-1733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherEIN