Northern Liberties Wellness Group

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

OS011923 Issued in PA

Legal business name

NORTHERN LIBERTIES WELLNESS GROUP

Practice address

520 N Columbus Blvd
Suite 202
Philadelphia, PA 19123-4226

Phone

(215) 239-3097

Fax

(215) 239-3098

NPI assigned

Aug 6, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Lolamarie Davis

Title

Administrator

Phone

(215) 239-3096

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1438819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438819200000",
    "number": "1457737967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9900",
            "city": "HAMILTON",
            "state": "NJ",
            "postal_code": "086501900",
            "telephone_number": "215-239-3097",
            "fax_number": "215-239-3098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 N COLUMBUS BLVD",
            "address_2": "SUITE 202",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191234226",
            "telephone_number": "215-239-3097",
            "fax_number": "215-239-3098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN LIBERTIES WELLNESS GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-06",
        "last_updated": "2015-08-06",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "LOLAMARIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "215-239-3096",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "PA",
            "license": "DC002363",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "PA",
            "license": "OS011923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Northern Home for Children and Family Service
• Northern Home for Children and Family Service
• Northern Home for Children and Family Services
• Northern Home for Children and Family Services
• Northern Home for Children and Family Services
• Northern Libeties Wellness Center
• Northern Ophthalmic Associates
• Northern Ophthalmic Associates
• Kina Sherran Northington, B.A.
• Northland Hearing Centers, Inc (Philadephia Hearing Center)

• General Practice Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• General Practice Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.