1083620785 NPI number — EDO GINSBURG M.D.

Table of content: EDO GINSBURG M.D. (NPI 1083620785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083620785 NPI number — EDO GINSBURG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GINSBURG
Provider First Name:
EDO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1083620785
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2018
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 AVENUE
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:
19129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-707-3326
Provider Business Mailing Address Fax Number:
215-707-8028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3401 N BROAD ST
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:
19140-5103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-707-3326
Provider Business Practice Location Address Fax Number:
215-707-8028
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  MD060982L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30563 . This is a "HEALTH PARTNERS FRANKFORD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0016801070010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30567 . This is a "HEALTH PARTNERS BUCKS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 524339 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0016801070011 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0474519000 . This is a "KEYSTONE IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3056444 . This is a "AETNA CONTRACT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 524339 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01697 . This is a "HEALTH PARTNERS TORRES." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30002949 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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