Provider Demographics
NPI:1932376357
Name:NE PHYSICIAN SERVICES INC
Entity Type:Organization
Organization Name:NE PHYSICIAN SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-333-6888
Mailing Address - Street 1:3542 WELSH RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-2623
Mailing Address - Country:US
Mailing Address - Phone:215-333-6888
Mailing Address - Fax:
Practice Address - Street 1:9625 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2846
Practice Address - Country:US
Practice Address - Phone:215-637-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0097905012OtherKEYSTONE
PA505981OtherAETNA