Provider Demographics
NPI:1326557059
Name:EINSTEIN COMMUNITY HEALTH ASSOCIATES, INC
Entity Type:Organization
Organization Name:EINSTEIN COMMUNITY HEALTH ASSOCIATES, INC
Other - Org Name:ECHA PEDIATRICS
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERVISOR, ENROLLMENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-456-4694
Mailing Address - Street 1:5501 OLD YORK ROAD
Mailing Address - Street 2:KORMAN, SUITE 202
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 E OLNEY AVE STE 400
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-2470
Practice Address - Country:US
Practice Address - Phone:215-456-4694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015771700023Medicaid