| NPI | 1508380452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANTE L JACKSON Enrollment Lead 215-662-6187 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center Urgent Care |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health |
| 207Q00000X Family Medicine | |
| 207RH0002X Internal Medicine Hospice and Palliative Medicine | |
| 207RH0002X Internal Medicine Hospice and Palliative Medicine | |
| 207RH0003X Internal Medicine Hematology & Oncology | |
| 207ZP0105X Pathology Clinical Pathology/Laboratory Medicine | |
| 2084N0400X Psychiatry & Neurology Neurology | |
| 2085R0202X Radiology Diagnostic Radiology | |
| 208600000X Surgery | |
| 208C00000X Colon & Rectal Surgery | |
| 213EP1101X Podiatrist Primary Podiatric Medicine | |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2021-06-09 |