Healthcare Provider Details

I. General information

NPI: 1023634276
Provider Name (Legal Business Name): SCREWJACK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 PEBBLE HILL RD
DOYLESTOWN PA
18901-3008
US

IV. Provider business mailing address

2226 E CLEARFIELD ST
PHILADELPHIA PA
19134-3750
US

V. Phone/Fax

Practice location:
  • Phone: 844-947-2739
  • Fax:
Mailing address:
  • Phone: 215-425-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JONATHAN NOAH DEROSE
Title or Position: REQUISITION REGISTRAR
Credential:
Phone: 215-425-2400