Healthcare Provider Details

I. General information

NPI: 1790323517
Provider Name (Legal Business Name): EINSTEIN PRACTICE PLAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD BLDG FL4
PHILADELPHIA PA
19141-3018
US

IV. Provider business mailing address

101 E OLNEY AVE FL 4
PHILADELPHIA PA
19120-2480
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-7900
  • Fax: 215-456-3428
Mailing address:
  • Phone: 215-456-8129
  • Fax: 215-456-5926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARGARET NICHOLSON
Title or Position: MANAGER
Credential:
Phone: 215-456-8129