Healthcare Provider Details

I. General information

NPI: 1306940960
Provider Name (Legal Business Name): DREXEL UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N BROAD ST
PHILADELPHIA PA
19102-1121
US

IV. Provider business mailing address

1601 CHERRY ST SUITE 11511
PHILADELPHIA PA
19102-1321
US

V. Phone/Fax

Practice location:
  • Phone: 215-762-7963
  • Fax: 215-762-5793
Mailing address:
  • Phone: 215-255-7822
  • Fax: 215-255-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number
License Number StatePA

VIII. Authorized Official

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