Provider Demographics
NPI:1942254511
Name:UNIVERSITY NEUROSURGICAL, PC
Entity Type:Organization
Organization Name:UNIVERSITY NEUROSURGICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAEID
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-331-0126
Mailing Address - Street 1:2630 HOLME AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3009
Mailing Address - Country:US
Mailing Address - Phone:215-331-0126
Mailing Address - Fax:215-331-0520
Practice Address - Street 1:2630 HOLME AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3009
Practice Address - Country:US
Practice Address - Phone:215-331-0126
Practice Address - Fax:215-331-0520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037547L204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0092191204OtherAMERICHOICE
PA0010204560002Medicaid
PA2362350000OtherKEYSTONE EAST
PA30830OtherKEYSTONE MERCY
PA00530OtherHEALTH PARTNERS
PA30039OtherAETNA
PA431597Medicare ID - Type Unspecified