| NPI | 1225426331 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANTE L JACKSON Enrollment Lead 215-662-6187 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery |
| 207YX0602X Otolaryngology, Otolaryngic Allergy | |
| 207YX0901X Otolaryngology, Otology & Neurotology | |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery | |
| Enumeration Date | 2014-12-26 |
| Last Update Date | 2020-11-19 |