Healthcare Provider Details

I. General information

NPI: 1518174630
Provider Name (Legal Business Name): ALBERT EINSTEIN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD PALEY BLDG, 1ST FLOOR. PEDIATRIC AND ADOLESCENT MEDICIN
PHILADELPHIA PA
19141-3018
US

IV. Provider business mailing address

2967 W SCHOOL HOUSE LN APT C 1003
PHILADELPHIA PA
19144-5222
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-7170
  • Fax:
Mailing address:
  • Phone: 267-979-6626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT 188183
License Number StatePA

VIII. Authorized Official

Name: CAROLINA PENA-RICARDO
Title or Position: PEDIATRIC RESIDENT
Credential: M.D.
Phone: 215-456-3436