1205904885 NPI number — JEFFERSON HEALTH - NORTHEAST

Table of content: (NPI 1205904885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205904885 NPI number — JEFFERSON HEALTH - NORTHEAST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFERSON HEALTH - NORTHEAST
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:
1205904885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 781001
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:
19178-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-481-6873
Provider Business Mailing Address Fax Number:
215-481-3985

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
380 OXFORD VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANGHORNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19047-8304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-949-5000
Provider Business Practice Location Address Fax Number:
215-710-3731
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GALUP
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-612-5038

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  061801 , 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: 0001010000 . This is a "KEYSTONE, IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2072992 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007705250041 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0001010000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 08277 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4193300 . This is a "MEDICAID OF NEW JERSEY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 60058 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0073204904 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 6491565 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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