Lyceum Physical Medicine, Pc

LBN: Lyceum Physical Medicine, Pc
Lyceum Physical Medicine, Pc is an health care organization with primary practice located at 6062 Ridge Avenue , Philadelphia PA 19128. The organization recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, Allopathic & Osteopathic Physicians / General Practice, Suppliers / Durable Medical Equipment & Medical Supplies. Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation is the primary health care specialty. Lyceum Physical Medicine, Pc can be contacted via phone (215) 508-5555, or through Pezzello, William J via phone (215) 508-5555.

Contact Information

Primary practice address
6062 Ridge Avenue Philadelphia PA 19128
Phone: (215) 508-5555
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Pezzello, William J Doctor of Chiropractic (DC)
Phone: (215) 508-5555

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X
Allopathic & Osteopathic Physicians / General Practice 208D00000X MD034915E Pennsylvania
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X MD032971E Pennsylvania

Profile Details

NPI number 1235422759
LBN Legal business name Lyceum Physical Medicine, Pc
DBA Doing business as
Authorized official Pezzello, William J Doctor of Chiropractic (DC)
Entity Organization
Organization subpart 1 No
Enumeration date May 17th, 2011
Last updated Aug 10th, 2015 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235422759 NPPES
Pennsylvania MEDICAID 1137870

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