Basic Information
Provider Information
NPI: 1245297605
EntityType: 2
ReplacementNPI:  
OrganizationName: EINSTEIN PRACTICE PLAN INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: EINSTEIN PULMONARY ASSOCIATES
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 101 E OLNEY AVE
Address2: SUITE 400
City: PHILADELPHIA
State: PA
PostalCode: 19120
CountryCode: US
TelephoneNumber: 2154567000
FaxNumber: 2152542599
Practice Location
Address1: 5401 OLD YORK RD
Address2: SUITE 363 - KLEIN BLDG
City: PHILADELPHIA
State: PA
PostalCode: 19141
CountryCode: US
TelephoneNumber: 2154566950
FaxNumber: 2154551933
Other Information
ProviderEnumerationDate: 04/28/2006
LastUpdateDate: 11/01/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: BARGERON
AuthorizedOfficialFirstName: FRANCINE
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: DIRECTOR-EINSTEIN PRACTICE PLAN INC
AuthorizedOfficialTelephone: 2154567000
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RP1001X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

ID Information
IDTypeStateIssuerDescription
100770623013905PA MEDICAID


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