1093453011 NPI number — PENN PRESPYTERIAN MEDICAL CENTER OF THE UNIVERSITY OF PENNSYLVANIA HEA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093453011 NPI number — PENN PRESPYTERIAN MEDICAL CENTER OF THE UNIVERSITY OF PENNSYLVANIA HEA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENN PRESPYTERIAN MEDICAL CENTER OF THE UNIVERSITY OF PENNSYLVANIA HEA
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:
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:
1093453011
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
51 N 39TH STREET
Provider Second Line Business Mailing Address:
CUPP BASEMENT-PHARMACY
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-662-8213
Provider Business Mailing Address Fax Number:
215-243-4644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1865 ROUTE 70 EAST
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-433-2877
Provider Business Practice Location Address Fax Number:
856-396-3416
Provider Enumeration Date:
05/20/2022

Additional Information

Authorized Official

Authorized Official Last Name:
RUSSELL
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSOCIATE EXECUTIVE DIRECTOR/COO
Authorized Official Telephone Number:
215-662-9108

Provider Taxonomy Codes

  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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