Healthcare Provider Details

I. General information

NPI: 1932645447
Provider Name (Legal Business Name): CAJULIS PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 RED LION RD SUITE 215
PHILADELPHIA PA
19114-1445
US

IV. Provider business mailing address

3998 RED LION RD SUITE 215
PHILADELPHIA PA
19114-1445
US

V. Phone/Fax

Practice location:
  • Phone: 215-632-5437
  • Fax: 215-824-4114
Mailing address:
  • Phone: 215-632-5437
  • Fax: 215-824-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD426695
License Number StatePA

VIII. Authorized Official

Name: DR. JINN WIEN CAJULIS
Title or Position: MD
Credential: MD
Phone: 215-632-5437