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General NPI Number Information
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NPI Number | 1992824312
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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 | 05/23/2024
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Provider Practice Location Address
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Address Line | 1233 LOCUST ST SUITE 201
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5453
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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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Provider Business Mailing Address
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Address Line | 1233 LOCUST ST SUITE 401
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5453
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | N8LT6601
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License Number State | PA
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