Basic Information
| Provider Information | |||||||||
| NPI: | 1356659379 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEFFERSON UNIVERSITY PHYSICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 MARKET ST FL 30 | ||||||||
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| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191072934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159551175 | ||||||||
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| Practice Location | |||||||||
| Address1: | 33 S 9TH ST | ||||||||
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| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159558516 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2010 | ||||||||
| LastUpdateDate: | 12/13/2020 | ||||||||
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| AuthorizedOfficialLastName: | RISTAS | ||||||||
| AuthorizedOfficialFirstName: | HRISTOS | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTORY | ||||||||
| AuthorizedOfficialTelephone: | 2159559298 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QH0002X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | 207QG0300X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
No ID Information.