Basic Information
| Provider Information | |||||||||
| NPI: | 1124147277 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THOMAS JEFFERSON UNIVERSITY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 329 SKIPPACK PIKE | ||||||||
| Address2: | |||||||||
| City: | FORT WASHINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190342011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157934035 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 S 11TH ST | ||||||||
| Address2: | SUITE 8270 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159554038 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | OSOWSKI | ||||||||
| AuthorizedOfficialFirstName: | ROE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF PRACTICE OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 2159554038 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | RN303254L | PA | Y | Hospitals | General Acute Care Hospital |
No ID Information.