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General NPI Number Information
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NPI Number | 1578723839
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Entity Type | Organization
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Legal Business Name | THOMAS JEFFERSON UNIVERSITY PSYCH
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Dates
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Enumeration Date | 06/11/2008
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 833 CHESTNUT ST STE 630
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4416
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Country | US
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Telephone | 215-955-0800
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Fax |
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Provider Business Mailing Address
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Address Line | 833 CHESTNUT ST STE 630
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4416
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Country | US
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Telephone | 215-955-0800
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JOHN OGUNKEYE
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Credential |
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Telephone | 215-955-2562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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