MEDICARE: JEFFERSON UNIVERSITY PHYSICIANS OF NEW JERSEY, P.C.

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	207RG0100X	Gastroenterology Physician		PA

General Provider Information

NPI Number	:	1881077832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFERSON UNIVERSITY PHYSICIANS OF NEW JERSEY, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 828937 SUITE 630
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-8937
Country	:	US
Telephone Number	:	215-503-1240
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 S. 9TH ST STE 630
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4416
Country	:	US
Telephone Number	:	215-955-0800
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	DAWN PADGETT
Credential	:
Telephone Number	:	215-955-1175

Provider Enumeration Date	:	07/08/2015
Last Update Date	:	06/13/2024

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