Basic Information
| Provider Information | |||||||||
| NPI: | 1245891654 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EINSTEIN PRACTICE PLAN INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 E OLNEY AVE FL 4 | ||||||||
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| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191202421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154568129 | ||||||||
| FaxNumber: | 2152543289 | ||||||||
| Practice Location | |||||||||
| Address1: | 5401 OLD YORK RD BLDG STE 410 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191413030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154567180 | ||||||||
| FaxNumber: | 2152544562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2019 | ||||||||
| LastUpdateDate: | 06/26/2019 | ||||||||
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| AuthorizedOfficialLastName: | NICHOLSON | ||||||||
| AuthorizedOfficialFirstName: | MARGARET | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2154568129 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.