Organization
INDEPEDENCE MEDICAL ASSOCIATES P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAY GLICKMAN (PHYSICIAN)
(215) 612-1450
Entity
Organization
Contact information
Practice address
3790 MORRELL AVE, PHILADELPHIA, PA 19114-1955
(215) 612-1450
(215) 612-1420
Mailing address
3790 MORRELL AVE, PHILADELPHIA, PA 19114-1955
(215) 612-1450
(215) 612-1420
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS 009194-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2222546001
KEYSTONE HMO ID
PA
Enumeration date
06/27/2006
Last updated
10/27/2008
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