1255632436 NPI number — TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION

Table of content: (NPI 1255632436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255632436 NPI number — TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TEMPLE REHABILITATION ASSOCIATES NJ
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255632436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2450 W HUNTING PARK AVE
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19129-1302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-707-8561
Provider Business Mailing Address Fax Number:
215-707-3677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 GREENTREE CTR
Provider Second Line Business Practice Location Address:
ROUTE 73 N
Provider Business Practice Location Address City Name:
MARLTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08053-3105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-596-0906
Provider Business Practice Location Address Fax Number:
856-596-6918
Provider Enumeration Date:
11/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
TRACEY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF REVENUE CYCLE OFFICER
Authorized Official Telephone Number:
215-707-4739

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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