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General NPI Number Information
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NPI Number | 1093298887
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Entity Type | Organization
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Legal Business Name | TEMPLE FACULTY PRACTICE PLAN, INC
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Dates
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Enumeration Date | 09/08/2018
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 333 COTTMAN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19111-2434
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Country | US
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Telephone | 215-728-6900
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Fax |
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Provider Business Mailing Address
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Address Line | 3509 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-4105
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Country | US
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Telephone | 215-707-3040
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Fax | 215-707-8235
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Authorized Official
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Title or Position | SR. MANAGER PAYER CRED
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Name | BRIDGET FERRARIE
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Credential |
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Telephone | 215-707-2433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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