Healthcare Provider Details

I. General information

NPI: 1821983750
Provider Name (Legal Business Name): SOPHIA R GEFFEN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 MARKET ST
PHILADELPHIA PA
19104-3329
US

IV. Provider business mailing address

1927 MIFFLIN ST
PHILADELPHIA PA
19145-2020
US

V. Phone/Fax

Practice location:
  • Phone: 800-879-2467
  • Fax:
Mailing address:
  • Phone: 508-642-7630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP032685
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: