Provider Demographics
NPI:1609936947
Name:HENRY AVE PHCY
Entity type:Organization
Organization Name:HENRY AVE PHCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SADEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-483-3300
Mailing Address - Street 1:5830 HENRY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1701
Mailing Address - Country:US
Mailing Address - Phone:215-483-3300
Mailing Address - Fax:215-483-5471
Practice Address - Street 1:5830 HENRY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1701
Practice Address - Country:US
Practice Address - Phone:215-483-3300
Practice Address - Fax:215-483-5471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-09
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP-415575-L332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
3976480OtherNABP
PA0017647900001Medicaid
PA5001430001Medicare NSC