Basic Information
| Provider Information | |||||||||
| NPI: | 1518174630 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALBERT EINSTEIN MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2967 W SCHOOL HOUSE LN | ||||||||
| Address2: | APT C 1003 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191445222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2679796626 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5501 OLD YORK RD | ||||||||
| Address2: | PALEY BLDG, 1ST FLOOR. PEDIATRIC AND ADOLESCENT MEDICIN | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191413018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154567170 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 05/29/2009 | ||||||||
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| AuthorizedOfficialLastName: | PENA-RICARDO | ||||||||
| AuthorizedOfficialFirstName: | CAROLINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PEDIATRIC RESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2154563436 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | MT 188183 | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.