Organization
ST MONICA MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL CZEKNER (CHIEF FINANCIAL OFFICER)
(215) 368-0900
Entity
Organization
Contact information
Practice address
2509 S 4TH ST, PHILADELPHIA, PA 19148-4712
(215) 271-1080
(215) 368-5254
Mailing address
2509 S 4TH ST, PHILADELPHIA, PA 19148-4712
(215) 271-1080
(215) 368-5254
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
232602
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5329640001
NSC DME SUPPLIER #
—
Enumeration date
11/29/2006
Last updated
08/22/2020
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