Provider Demographics
NPI:1982657987
Name:ASOCIACION PUERTORRIQUENOS EN MARCHA
Entity Type:Organization
Organization Name:ASOCIACION PUERTORRIQUENOS EN MARCHA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:ERRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-235-6788
Mailing Address - Street 1:4301 RISING SUN AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140
Mailing Address - Country:US
Mailing Address - Phone:267-972-7200
Mailing Address - Fax:215-455-6501
Practice Address - Street 1:2147 N 6TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-1415
Practice Address - Country:US
Practice Address - Phone:215-235-7555
Practice Address - Fax:215-769-7025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA134920261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1003114240018Medicaid
PA1003114240018Medicaid