Basic Information
| Provider Information | |||||||||
| NPI: | 1730396839 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALBERT EINSTEIN MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2043A S JOHN RUSSELL CIR | ||||||||
| Address2: | |||||||||
| City: | ELKINS PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190271016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166372889 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5501 OLD YORK RD | ||||||||
| Address2: | LIFTER 1ST FLR, RM 1615 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191413018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154568261 | ||||||||
| FaxNumber: | 2154562386 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BERNINI | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 2154567890 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| AuthorizedOfficialCredential: | C.O.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | MT188002 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.