Healthcare Provider Details

I. General information

NPI: 1255409405
Provider Name (Legal Business Name): THOMAS JEFFERSON UNIVERSITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 11TH ST 2210 GIBBON BUILDING
PHILADELPHIA PA
19107-4824
US

IV. Provider business mailing address

PO BOX 85009895
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-7106
  • Fax: 215-955-8732
Mailing address:
  • Phone: 215-955-7106
  • Fax: 215-955-8732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number200801
License Number StatePA

VIII. Authorized Official

Name: MR. NEIL LUBARSKY
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 215-955-9895