MEDICARE: JEFFERSON UNIVERSITY PHYSICIANS

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	207K00000X	Allergy & Immunology Physician

General Provider Information

NPI Number	:	1952860975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFERSON UNIVERSITY PHYSICIANS

Provider Business Mailing Address
First Line	:	PO BOX 828937
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	:	1015 CHESTNUT ST STE 1300
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4313
Country	:	US
Telephone Number	:	215-955-7410
Fax Number	:	215-923-8230

Authorized Official
Title or Position	:	VP OF CONTRACTING
Name	:	HRISTOS RISTAS
Credential	:
Telephone Number	:	215-955-9298

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	10/14/2022

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