Basic Information
| Provider Information | |||||||||
| NPI: | 1326192337 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHILADELPHIA HEALTH & EDUCATION CORP | ||||||||
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| OtherOrganizationName: | DREXEL INFERTILITY SVCS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 CHERRY ST | ||||||||
| Address2: | SUITE 11511 | ||||||||
| City: | PHILA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191021321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152557822 | ||||||||
| FaxNumber: | 2152557825 | ||||||||
| Practice Location | |||||||||
| Address1: | 4190 CITY AVE | ||||||||
| Address2: | ROWLAND HALL, SUITE 418 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191311626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154774960 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 04/15/2014 | ||||||||
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| AuthorizedOfficialLastName: | MEINDEL | ||||||||
| AuthorizedOfficialFirstName: | LOU | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR. EXECUTIVE DIRECTOR OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 2157621321 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VE0102X | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Reproductive Endocrinology |
ID Information
| ID | Type | State | Issuer | Description | 1839976 | 01 | PA | HIGHMARK PA BS GROUP # | OTHER |