Healthcare Provider Details

I. General information

NPI: 1942345095
Provider Name (Legal Business Name): DREXEL UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 WHITE HORSE PIKE
HADDON HEIGHTS NJ
08035-1908
US

IV. Provider business mailing address

1601 CHERRY ST SUITE 11511
PHILADELPHIA PA
19102-1321
US

V. Phone/Fax

Practice location:
  • Phone: 856-546-5353
  • Fax:
Mailing address:
  • Phone: 215-255-7822
  • Fax: 215-255-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: DAVID JANIEC
Title or Position: DIRECTOR OF PAYER CONTRACTING
Credential:
Phone: 215-255-7766