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General NPI Number Information
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NPI Number | 1972622306
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Entity Type | Organization
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Legal Business Name | THOMAS JEFFERSON UNIVERSITY
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 10/17/2017
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Provider Practice Location Address
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Address Line | 1239 SPRING GARDEN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19123-3206
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Country | US
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Telephone | 215-763-1020
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Fax | 215-763-4640
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Provider Business Mailing Address
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Address Line | 1233 LOCUST ST STE 401
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5459
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Country | US
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Telephone | 215-955-1952
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Fax | 215-568-6414
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MICHELLE CALVANO
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Credential | BA
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Telephone | 215-955-1952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 800000127
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License Number State | PA
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