Healthcare Provider Details

I. General information

NPI: 1912954116
Provider Name (Legal Business Name): DAMYANTI JUNEJA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 03/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S 60TH ST
PHILADELPHIA PA
19143-2312
US

IV. Provider business mailing address

1314 BOBARN DR
NARBERTH PA
19072-1136
US

V. Phone/Fax

Practice location:
  • Phone: 215-748-1143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD035169L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: