Healthcare Provider Details

I. General information

NPI: 1538211552
Provider Name (Legal Business Name): EINSTEIN PRACTICE PLAN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 OLD YORK RD KLEIN 363
PHILADELPHIA PA
19141-3030
US

IV. Provider business mailing address

101 E OLNEY AVE SUITE 400
PHILADELPHIA PA
19120-2421
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-8216
  • Fax: 215-455-1933
Mailing address:
  • Phone: 215-456-7000
  • Fax: 215-254-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: FRANCINE BARGERON
Title or Position: DIRECTOR
Credential:
Phone: 215-456-7000