1104882786 NPI number — EINSTEIN PRACTICE PLAN INC

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 1104882786 NPI number — EINSTEIN PRACTICE PLAN INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EINSTEIN PRACTICE PLAN 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:
1104882786
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 E OLNEY AVE
Provider Second Line Business Mailing Address:
STE 400
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-456-7000
Provider Business Mailing Address Fax Number:
215-254-2599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 E TOWNSHIP LINE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKINS PARK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-663-6677
Provider Business Practice Location Address Fax Number:
215-456-9491
Provider Enumeration Date:
04/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARGERON
Authorized Official First Name:
FRANCINE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
215-456-7000

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)

  • Identifier: 1007706230139 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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