Provider Demographics
NPI:1538605118
Name:PENN ACUPUNCTURE PARTNERS
Entity type:Organization
Organization Name:PENN ACUPUNCTURE PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:SELCOVA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:215-220-3842
Mailing Address - Street 1:10065 SANDMEYER LN
Mailing Address - Street 2:STE 301
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3515
Mailing Address - Country:US
Mailing Address - Phone:215-220-3842
Mailing Address - Fax:
Practice Address - Street 1:1500 MARKET ST
Practice Address - Street 2:12TH FLOOR EAST TOWER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2100
Practice Address - Country:US
Practice Address - Phone:215-220-3842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001022171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty