Provider Demographics
NPI:1366498479
Name:THE PHILIP JAISOHN MEMORIAL FOUNDATION, INC
Entity Type:Organization
Organization Name:THE PHILIP JAISOHN MEMORIAL FOUNDATION, INC
Other - Org Name:JAISOHN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE JUNG
Authorized Official - Middle Name:SOO
Authorized Official - Last Name:CHOE
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT & CEO
Authorized Official - Phone:215-224-2000
Mailing Address - Street 1:6705 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19126-2841
Mailing Address - Country:US
Mailing Address - Phone:215-224-2000
Mailing Address - Fax:215-224-8651
Practice Address - Street 1:6705 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19126-2841
Practice Address - Country:US
Practice Address - Phone:215-224-2000
Practice Address - Fax:215-224-8651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007340700003Medicaid