Provider Demographics
NPI:1164956330
Name:JEAN CLAUDE ST. GERMAIN
Entity Type:Organization
Organization Name:JEAN CLAUDE ST. GERMAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN-CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. GERMAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-472-2550
Mailing Address - Street 1:49 N 52ND ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-2644
Mailing Address - Country:US
Mailing Address - Phone:215-472-2550
Mailing Address - Fax:215-472-2551
Practice Address - Street 1:49 N 52ND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-2644
Practice Address - Country:US
Practice Address - Phone:215-472-2550
Practice Address - Fax:215-472-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00707046Medicaid