Healthcare Provider Details

I. General information

NPI: 1760434468
Provider Name (Legal Business Name): EINSTEIN PRACTICE PLAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK ROAD
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: 215-456-7240
  • Fax: 215-456-7850
Mailing address:
  • Phone: 215-456-7000
  • Fax: 215-254-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

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