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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