1205246576 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 1205246576 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:
1205246576
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 788735
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:
19178-8735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-456-7000
Provider Business Mailing Address Fax Number:
215-254-3289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 W TABOR RD
Provider Second Line Business Practice Location Address:
MOSS REHAB BUILDING, 4TH FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19141-3019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-456-3815
Provider Business Practice Location Address Fax Number:
215-456-6803
Provider Enumeration Date:
05/07/2014

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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