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Organization
LYCEUM PHYSICAL MEDICINE, PC
Active
Organization
LYCEUM PHYSICAL MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM J PEZZELLO DC (OWNER)
(215) 508-5555
Entity
Organization
Contact information
Practice address
6062 RIDGE AVENUE, PHILADELPHIA, PA 19128
(215) 508-5555
Mailing address
6062 RIDGE AVENUE, PHILADELPHIA, PA 19128
(215) 508-5555
(215) 508-5554
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
208D00000X
General Practice Physician
MD034915E
PA
332B00000X
Durable Medical Equipment & Medical Supplies
MD032971E
PA
Other
Enumeration date
05/17/2011
Last updated
08/10/2015
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