=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437388345
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THOMAS JEFFERSON UNIVERSITY HOSPITAL, DEPARTMENT OF NEUROSURGERY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2009
-----------------------------------------------------
Last Update Date | 07/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 909 WALNUT ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107-5211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-955-7008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2609 ATLANTIC AVE APT 1
-----------------------------------------------------
City | LONGPORT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08403-1200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-343-7796
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | MS. CHRISTINA MARY DEFAMIO
-----------------------------------------------------
Credential | CRNP
-----------------------------------------------------
Telephone | 856-343-7796
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------