Organization
JEFFERSON UNIVERSITY PHYSICIANS
Active
Organization
JEFFERSON UNIVERSITY PHYSICIANS
Active
Other names
Jefferson Center for Vascular Disease
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN OGUNKEYE (EXECUTIVE DIRECTOR)
(215) 955-2562
Entity
Organization
Contact information
Practice address
833 CHESTNUT ST, SUITE 630, JUP CENTRAL ENROLLMENTS, PHILADELPHIA, PA 19107-4414
(215) 955-0800
Mailing address
833 CHESTNUT ST, SUITE 630, JUP CENTRAL ENROLLMENTS, PHILADELPHIA, PA 19107-4414
(215) 955-0800
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3714640000
KEYSTONE (IBC)
PA
01
—
6946085
AETNA
PA
01
—
PENDING
KEYSTONE MERCY
PA
Enumeration date
07/20/2009
Last updated
07/20/2009
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