Organization
JEFFERSON UNIVERSITY PHYSICIANS
Active
Other names
Urology
Organization subpart
No
Provider details
NPI number
Authorized official
HRISTOS RISTAS (VP OF NETWORK OPERATIONS)
(215) 955-9298
Entity
Organization
Contact information
Practice address
33 S 9TH ST STE 703, PHILADELPHIA, PA 19107-4408
(215) 955-1000
Mailing address
1101 MARKET ST FL 30, PHILADELPHIA, PA 19107-2934
(215) 955-1175
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0445135000
INDEPENDENCE BLUE CROSS
PA
01
—
120728
AETNA
PA
01
—
2370033000
AMERIHEALTH
PA
01
—
32944
KEYSTONE MERCY
PA
05
—
7548109
—
NJ
01
—
959635
HIGHMARK BLUE SHIELD
PA
Enumeration date
04/18/2008
Last updated
12/13/2020
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