| NPI | 1194829739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANTE L JACKSON Enrollment Lead 215-662-6187 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease |
| 103T00000X Psychologist | |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2020-11-19 |