Healthcare Provider Details

I. General information

NPI: 1952819633
Provider Name (Legal Business Name): EINSTEIN PRACTICE PLAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD FL MOSS3
PHILADELPHIA PA
19141
US

IV. Provider business mailing address

PO BOX 788735
PHILADELPHIA PA
19178-8735
US

V. Phone/Fax

Practice location:
  • Phone: 215-663-1188
  • Fax:
Mailing address:
  • Phone: 215-456-7000
  • Fax: 215-456-5926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: DAWN CANDIA
Title or Position: PROVIDER ENROLLMENT
Credential:
Phone: 215-456-4694