Healthcare Provider Details

I. General information

NPI: 1629187836
Provider Name (Legal Business Name): JONATHAN E OSTROFF DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2966 STREET RD
BENSALEM PA
19020-2604
US

IV. Provider business mailing address

PO BOX 8500-6335
PHILADELPHIA PA
19178-6335
US

V. Phone/Fax

Practice location:
  • Phone: 215-638-0666
  • Fax: 215-638-3320
Mailing address:
  • Phone: 215-638-0666
  • Fax: 215-638-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS004426L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: