Basic Information
| Provider Information | |||||||||
| NPI: | 1154330231 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEKRET | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1503 LANSDOWNE AVE | ||||||||
| Address2: | SUITE 3005 | ||||||||
| City: | DARBY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190231330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105241552 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1503 LANSDOWNE AVE | ||||||||
| Address2: | SUITE 3005 | ||||||||
| City: | DARBY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190231330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105241552 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD015541E | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 0007491350006 | 05 | PA | MEDICAID | 0046415000 | 01 | PA | PERSONAL CHOICE | OTHER |