Provider Demographics
NPI:1750935987
Name:ROBBALAA, MUHAMMAD L.
Entity type:Individual
Prefix:
First Name:MUHAMMAD L.
Middle Name:
Last Name:ROBBALAA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 W 3RD ST # A
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3622
Mailing Address - Country:US
Mailing Address - Phone:215-435-4203
Mailing Address - Fax:
Practice Address - Street 1:1120 W 3RD ST # A
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3622
Practice Address - Country:US
Practice Address - Phone:215-435-4203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YP1600X, 172A00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1033772405Medicaid