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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