Provider Demographics
NPI:1235378209
Name:THOMAS JEFFERSON UNIVERSITY
Entity Type:Organization
Organization Name:THOMAS JEFFERSON UNIVERSITY
Other - Org Name:JEFFERSON ELDER CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, OTR/L
Authorized Official - Phone:215-503-2896
Mailing Address - Street 1:130 S 9TH ST
Mailing Address - Street 2:SUITE 647
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5233
Mailing Address - Country:US
Mailing Address - Phone:215-503-6791
Mailing Address - Fax:
Practice Address - Street 1:130 S 9TH ST
Practice Address - Street 2:SUITE 647
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5233
Practice Address - Country:US
Practice Address - Phone:215-503-6791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAN/A1041C0700X, 225100000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA154094Medicare PIN
NJ219334Medicare PIN