Healthcare Provider Details

I. General information

NPI: 1497904049
Provider Name (Legal Business Name): TEMPLE PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8025 CASTOR AVE
PHILA PA
19152-2733
US

IV. Provider business mailing address

PO BOX 820933
PHILA PA
19182-0933
US

V. Phone/Fax

Practice location:
  • Phone: 215-745-9900
  • Fax: 215-745-9902
Mailing address:
  • Phone: 215-926-9010
  • Fax: 215-226-8285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ERIC MANKIN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 215-926-9050