Provider Demographics
NPI:1437388345
Name:THOMAS JEFFERSON UNIVERSITY HOSPITAL, DEPARTMENT OF NEUROSURGERY
Entity Type:Organization
Organization Name:THOMAS JEFFERSON UNIVERSITY HOSPITAL, DEPARTMENT OF NEUROSURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:DEFAMIO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:856-343-7796
Mailing Address - Street 1:2609 ATLANTIC AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LONGPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08403-1200
Mailing Address - Country:US
Mailing Address - Phone:856-343-7796
Mailing Address - Fax:
Practice Address - Street 1:909 WALNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5211
Practice Address - Country:US
Practice Address - Phone:215-955-7008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA009243OtherCRNP PRESCRIPTIVE AUTHORITY