Healthcare Provider Details

I. General information

NPI: 1558554212
Provider Name (Legal Business Name): JELLINEK PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 ROUTE 202 SUITE 100
DOYLESTOWN PA
18902-6601
US

IV. Provider business mailing address

3655 ROUTE 202 SUITE 100
DOYLESTOWN PA
18902-6601
US

V. Phone/Fax

Practice location:
  • Phone: 215-230-7290
  • Fax: 215-230-7291
Mailing address:
  • Phone: 215-230-7290
  • Fax: 215-230-7291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number068431L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. SHARON S. JELLINEK
Title or Position: OWNER
Credential: 068431L
Phone: 215-230-7290