Basic Information
| Provider Information | |||||||||
| NPI: | 1356496038 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHILADELPHIA HEALTH & EDUCATION CORPORATION | ||||||||
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| OtherOrganizationName: | DREXEL GYNECOLOGY-ONCOLOGY SERVICES | ||||||||
| 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: | 246 NORTH BROAD ST | ||||||||
| Address2: | 15TH FLOOR SOUTH TOWER | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157622640 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 04/15/2014 | ||||||||
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| AuthorizedOfficialLastName: | MEINDEL | ||||||||
| AuthorizedOfficialFirstName: | LOU | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR. EXECUTIVE DIRECTOR OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 2152557822 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0201X | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
ID Information
| ID | Type | State | Issuer | Description | 184037 | 01 | PA | HIGHMARK PA BS GROUP # | OTHER |