Graduated: 1987
NPI: 1467426247
Practice Locations (2)
EASTERN PENNSYLVANIA PHYSICIAN ALLIANCE, LLC
4641 ROOSEVELT BLVD
PHILADELPHIA, PA 191242343
2158314600
NORTHEAST COMMUNITY CENTER FOR MENTAL HEALTH-MENTAL RETARDATION I
ROOSEVELT BLVD AT ADAMS
PHILADELPHIA, PA 191241552
2158312800
Source: CMS National Downloadable File, September 2026.