Basic Information
| Provider Information | |||||||||
| NPI: | 1851592620 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALBERT EINSTEIN MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 MATTISON AVE | ||||||||
| Address2: | |||||||||
| City: | AMBLER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190024719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156462413 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5501 OLD YORK RD | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191413018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154566336 | ||||||||
| FaxNumber: | 2154568502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2007 | ||||||||
| LastUpdateDate: | 06/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | BERNINI | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATIONS OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2154567890 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | C.O.O | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | MT185895 | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | MT185895 | 01 | PA | TRAINING LICENSE | OTHER |