Provider Demographics
NPI:1528845682
Name:MHP CITY AVE LLC
Entity type:Organization
Organization Name:MHP CITY AVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-243-6730
Mailing Address - Street 1:48A E RIDGE PIKE
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428
Mailing Address - Country:US
Mailing Address - Phone:484-243-6730
Mailing Address - Fax:
Practice Address - Street 1:2231 BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-2530
Practice Address - Country:US
Practice Address - Phone:484-243-6730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERION HEALTH PARTNERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care