| NPI | 1477658599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANTE L JACKSON Enrollment Lead 215-662-6187 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2020-11-19 |