Healthcare Provider Details

I. General information

NPI: 1992761621
Provider Name (Legal Business Name): EINSTEIN PRACTICE PLAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 11/01/2007
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 E OLNEY AVENUE SUITE 400
PHILADELPHIA PA
19120
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-6930
  • Fax: 215-456-3529
Mailing address:
  • Phone: 215-456-7000
  • Fax: 215-254-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

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