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NPI Code Detail

MEDICARE: DR. JOSE BOSSBALY M.D.

MEDICARE: DR. JOSE BOSSBALY 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
1207R00000XInternal Medicine PhysicianMD040261LPA

General Provider Information

NPI Number : 1376551101
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSE BOSSBALY M.D.
Provider Business Mailing Address
First Line : 136 DIAMOND ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19122-1721
Country : US
Telephone Number : 215-426-8100
Fax Number : 215-965-2344
Provider Business Practice Location Address
First Line : 136 DIAMOND ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19122-1721
Country : US
Telephone Number : 215-426-8100
Fax Number : 215-965-2344
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2006
Last Update Date : 11/07/2018

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Directions to “ DR. JOSE BOSSBALY M.D.” Practice Location

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