1366498479 NPI number — THE PHILIP JAISOHN MEMORIAL FOUNDATION, INC

Table of content: MS. JILL ELIZABETH ANDERSON LMP (NPI 1013225655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366498479 NPI number — THE PHILIP JAISOHN MEMORIAL FOUNDATION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE PHILIP JAISOHN MEMORIAL FOUNDATION, INC
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:
Provider Other Organization Name Type Code:
6
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:
1366498479
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6705 OLD YORK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19126-2841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-224-2000
Provider Business Mailing Address Fax Number:
215-224-8651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6705 OLD YORK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19126-2841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-224-2000
Provider Business Practice Location Address Fax Number:
215-224-8651
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHOE
Authorized Official First Name:
GEORGE JUNG
Authorized Official Middle Name:
SOO
Authorized Official Title or Position:
CHAIRMAN
Authorized Official Telephone Number:
215-224-2000

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0007340700003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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