Provider Demographics
NPI:1285185751
Name:EINSTEIN PRACTICE PLAN
Entity Type:Organization
Organization Name:EINSTEIN PRACTICE PLAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SUNG MIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:215-456-8242
Mailing Address - Street 1:5401 OLD YORK RD
Mailing Address - Street 2:KLEIN BUILDING-SUITE 505
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3030
Mailing Address - Country:US
Mailing Address - Phone:215-456-8242
Mailing Address - Fax:215-456-8058
Practice Address - Street 1:5401 OLD YORK RD
Practice Address - Street 2:KLEIN BUILDING-SUITE 505
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3030
Practice Address - Country:US
Practice Address - Phone:215-456-8242
Practice Address - Fax:215-456-8058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058420363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty