| Jefferson Community Physicians-neurology | |
|
2301 S Broad St Philadelphia PA 19148-3542 | |
| (215) 952-9936 | |
| (215) 952-1247 |
| Full Name | Jefferson Community Physicians-neurology |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 2301 S Broad St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Hristas Ristos (VP OF CONTRACTING) |
| Authorized Official Contact | 2159559298 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jefferson Community Physicians-neurology Po Box 828937 Philadelphia PA 19182-8937 Ph: (215) 503-1240 | Jefferson Community Physicians-neurology 2301 S Broad St Philadelphia PA 19148-3542 Ph: (215) 952-9936 |
| NPI Number | 1902267230 |
|---|---|
| Provider Enumeration Date | 03/15/2016 |
| Last Update Date | 10/14/2022 |
| Certification Date | 10/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902267230 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (Pennsylvania) | Primary |
| 2084N0600X | Psychiatry & Neurology - Clinical Neurophysiology | (Pennsylvania) | Secondary |
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