MEDICARE: DR. JACK SAMUEL NEMEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD026922E	PA

General Provider Information

NPI Number	:	1336171651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK SAMUEL NEMEZ M.D.

Provider Business Mailing Address
First Line	:	7001 KINDRED ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19149-1724
Country	:	US
Telephone Number	:	215-745-5662
Fax Number	:	215-722-8722

Provider Business Practice Location Address
First Line	:	7001 KINDRED ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19149-1724
Country	:	US
Telephone Number	:	215-745-5662
Fax Number	:	215-722-8722

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/08/2007

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