Healthcare Provider Details

I. General information

NPI: 1013969690
Provider Name (Legal Business Name): EINSTEIN PRACTICE PLAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 OLD YORK ROAD SUITE 509
PHILADELPHIA PA
19141
US

IV. Provider business mailing address

101 EAST OLNEY AVE SUITE 400
PHILADELPHIA PA
19120
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-4985
  • Fax: 215-456-8058
Mailing address:
  • Phone: 215-456-7000
  • Fax: 215-254-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: FRANCINE BARGERON
Title or Position: DIRECTOR EINSTEIN PRACTICE PLAN INC
Credential:
Phone: 215-456-7000