Provider Demographics
NPI:1801499850
Name:AVICENNA PHYSICIAN SERVICES INC
Entity type:Organization
Organization Name:AVICENNA PHYSICIAN SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BILAL
Authorized Official - Middle Name:ARSHAD
Authorized Official - Last Name:MANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-645-8517
Mailing Address - Street 1:5148 HAMILTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9788
Mailing Address - Country:US
Mailing Address - Phone:610-904-8100
Mailing Address - Fax:610-638-0753
Practice Address - Street 1:5148 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9788
Practice Address - Country:US
Practice Address - Phone:610-904-8100
Practice Address - Fax:610-638-0753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty