# JEFFERSON UNIVERSITY PHYSICIANS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** JUP Ancillary Providers
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437425360
- **Authorized official:** MR. JOHN OGUNKEYE (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (215) 955-2562

## Contact information

- **Practice address:** 615 CHESTNUT ST, 14TH FLOOR, PHILADELPHIA, PA 19106-4495
- **Practice address phone:** (215) 955-9655
- **Mailing address:** 615 CHESTNUT ST, 14TH FLOOR, PHILADELPHIA, PA 19106-4495
- **Mailing address phone:** (215) 955-9655

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133N00000X | Nutritionist | — | PA | — |
| 363A00000X | Physician Assistant | — | PA | — |
| 363L00000X | Nurse Practitioner | — | PA | Yes |

## Other

- **Enumeration date:** 03/26/2012
- **Last updated:** 03/26/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1007729870101 | — | PA |