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General NPI Number Information
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NPI Number | 1861512055
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Entity Type | Organization
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Legal Business Name | CORE PEDIATRIC CARDIOLOGY, PC
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 205 YORKTOWN PLZ 8120 OLD YORK ROAD
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City | ELKINS PARK
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State | PA
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Zip | 19027-1424
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Country | US
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Telephone | 610-616-4138
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Fax |
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Provider Business Mailing Address
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Address Line | 205 YORKTOWN PLZ 8120 OLD YORK ROAD
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City | ELKINS PARK
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State | PA
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Zip | 19027-1424
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Country | US
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Telephone | 610-616-4138
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ZEV JACOBSON
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Credential | MD
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Telephone | 610-616-4138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | MD066670L
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License Number State | PA
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