Healthcare Provider Details

I. General information

NPI: 1386818540
Provider Name (Legal Business Name): JEFFERSON UNIVERSITY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CHESTNUT ST SUITE 630
PHILADELPHIA PA
19107-4414
US

IV. Provider business mailing address

833 CHESTNUT ST SUITE 630
PHILADELPHIA PA
19107-4414
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-0800
  • Fax:
Mailing address:
  • Phone: 215-955-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN OGUNKEYE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 215-955-2562