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General NPI Number Information
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NPI Number | 1639343890
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Entity Type | Organization
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Legal Business Name | JEFFERSON UNIVERSITY PHYSICIANS
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 12/13/2020
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Provider Practice Location Address
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Address Line | 33 S 9TH ST STE 703
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4408
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Country | US
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Telephone | 215-955-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 MARKET ST FL 30
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City | PHILADELPHIA
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State | PA
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Zip | 19107-2934
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Country | US
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Telephone | 215-955-1175
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Fax |
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Authorized Official
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Title or Position | VP OF NETWORK OPERATIONS
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Name | HRISTOS RISTAS
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Credential |
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Telephone | 215-955-9298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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