MEDICARE: BPS MEDICAL OF PENNSYLVANIA, PLLC

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

General Provider Information

NPI Number	:	1609315605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BPS MEDICAL OF PENNSYLVANIA, PLLC

Provider Business Mailing Address
First Line	:	4300 HADDONFIELD RD
Second Line	:
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08109-3376
Country	:	US
Telephone Number	:	973-909-5159
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 W OXFORD ST STE W-1200
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-3927
Country	:	US
Telephone Number	:	267-800-1009
Fax Number	:	267-800-1869

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. JESSICA SON
Credential	:	MD
Telephone Number	:	267-800-1009

Provider Enumeration Date	:	02/23/2017
Last Update Date	:	05/13/2022

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