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Organization
JEFFERSON UNIVERSITY PHYSICIANS
Active
Organization
JEFFERSON UNIVERSITY PHYSICIANS
Active
Other names
JUP Ancillary Providers
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN OGUNKEYE (EXECUTIVE DIRECTOR)
(215) 955-2562
Entity
Organization
Contact information
Practice address
615 CHESTNUT ST, 14TH FLOOR, PHILADELPHIA, PA 19106-4495
(215) 955-9655
Mailing address
615 CHESTNUT ST, 14TH FLOOR, PHILADELPHIA, PA 19106-4495
(215) 955-9655
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
PA
363A00000X
Physician Assistant
—
PA
363L00000X
Nurse Practitioner
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007729870101
—
PA
Enumeration date
03/26/2012
Last updated
03/26/2012
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