Healthcare Provider Details

I. General information

NPI: 1437388345
Provider Name (Legal Business Name): THOMAS JEFFERSON UNIVERSITY HOSPITAL, DEPARTMENT OF NEUROSURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 WALNUT ST
PHILADELPHIA PA
19107-5211
US

IV. Provider business mailing address

2609 ATLANTIC AVE APT 1
LONGPORT NJ
08403-1200
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-7008
  • Fax:
Mailing address:
  • Phone: 856-343-7796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. CHRISTINA MARY DEFAMIO
Title or Position: NURSE PRACTITIONER
Credential: CRNP
Phone: 856-343-7796