Healthcare Provider Details

I. General information

NPI: 1265923072
Provider Name (Legal Business Name): EINSTEIN PRACTICE PLAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 OLD YORK RD STE 505
PHILADELPHIA PA
19141-3047
US

IV. Provider business mailing address

101 E OLNEY AVE STE 400
PHILADELPHIA PA
19120-2470
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-8242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number
License Number StatePA

VIII. Authorized Official

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