Healthcare Provider Details

I. General information

NPI: 1497758452
Provider Name (Legal Business Name): JONATHAN YOAV GEFEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE SUITE 275 LANKENAU MED SCI BLDG.
WYNNEWOOD PA
19096-3450
US

IV. Provider business mailing address

100 E LANCASTER AVE SUITE 275 LANKENAU MED SCI BLDG.
WYNNEWOOD PA
19096-3450
US

V. Phone/Fax

Practice location:
  • Phone: 610-642-1908
  • Fax: 610-642-6808
Mailing address:
  • Phone: 610-642-1908
  • Fax: 610-642-6808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD423617
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: