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General NPI Number Information
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NPI Number | 1114095791
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Entity Type | Organization
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Legal Business Name | JEFFERSON HEALTH - NORTHEAST
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 4900 FRANKFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19124-2618
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Country | US
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Telephone | 215-831-2000
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Fax | 215-807-8217
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Provider Business Mailing Address
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Address Line | PO BOX 781001
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City | PHILADELPHIA
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State | PA
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Zip | 19178-1001
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Country | US
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Telephone | 215-481-6873
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Fax | 215-481-3985
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICHARD GALUP
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Credential |
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Telephone | 215-612-5038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 061801
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License Number State | PA
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