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833 Chestnut St Suite 630 Jup Central Enrollments Philadelphia PA 19107-4414 | |
| (215) 955-0800 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | General Practice |
| Location | 833 Chestnut St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | John Ogunkeye (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2159552562 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
833 Chestnut St Suite 630 Jup Central Enrollments Philadelphia PA 19107-4414 Ph: (215) 955-0800 | 833 Chestnut St Suite 630 Jup Central Enrollments Philadelphia PA 19107-4414 Ph: (215) 955-0800 |
| NPI Number | 1619110491 |
|---|---|
| Provider Enumeration Date | 04/09/2009 |
| Last Update Date | 04/09/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619110491 | NPI | - | NPPES |
| 0060238000 | Other | PA | INDEPENDENCE BLUE CROSSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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