| Lyceum Physical Medicine, Pc | |
|
6062 Ridge Avenue Philadelphia PA 19128 | |
| (215) 508-5555 | |
| Not Available |
| Full Name | Lyceum Physical Medicine, Pc |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 6062 Ridge Avenue, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | William J Pezzello (OWNER) |
| Authorized Official Contact | 2155085555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lyceum Physical Medicine, Pc 6062 Ridge Avenue Philadelphia PA 19128 Ph: (215) 508-5555 | Lyceum Physical Medicine, Pc 6062 Ridge Avenue Philadelphia PA 19128 Ph: (215) 508-5555 |
| NPI Number | 1235422759 |
|---|---|
| Provider Enumeration Date | 05/17/2011 |
| Last Update Date | 08/10/2015 |
| Medicare PECOS PAC ID | 6204006554 |
|---|---|
| Medicare Enrollment ID | O20110824000786 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235422759 | NPI | - | NPPES |
| 1137870 | Medicaid | PA |
| Provider Name | William J Pezzello |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1720278740 PECOS PAC ID: 1557358819 Enrollment ID: I20090714000667 |
| Provider Name | James Thomas Murphy |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1982898037 PECOS PAC ID: 6608943253 Enrollment ID: I20110614000807 |
| Provider Name | Patricia Woods |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760614655 PECOS PAC ID: 6901071430 Enrollment ID: I20111213000243 |
| Provider Name | Mary Teresa Kashurba |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1417082488 PECOS PAC ID: 5890959944 Enrollment ID: I20120621000202 |
| Provider Name | Sareta M Coubarous |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1558323196 PECOS PAC ID: 5799797791 Enrollment ID: I20141104002223 |
| Provider Name | Liji M Vipin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760856538 PECOS PAC ID: 6406140599 Enrollment ID: I20160812000393 |
| Provider Name | Paul L Ezeukwu |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1326175936 PECOS PAC ID: 6406959352 Enrollment ID: I20180301000205 |
| Provider Name | Geenander K Raju |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356823959 PECOS PAC ID: 2567713738 Enrollment ID: I20180927000450 |
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