Provider Demographics
NPI:1447217872
Name:EINSTEIN PRACTICE PLAN INC
Entity Type:Organization
Organization Name:EINSTEIN PRACTICE PLAN INC
Other - Org Name:EINSTEIN NORTHERN DIVISION MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR-EINSTEIN PRACTICE PLAN INC
Authorized Official - Prefix:
Authorized Official - First Name:FRANCINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARGERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-456-7000
Mailing Address - Street 1:101 E OLNEY AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120
Mailing Address - Country:US
Mailing Address - Phone:215-456-7000
Mailing Address - Fax:215-254-2599
Practice Address - Street 1:5401 OLD YORK RD
Practice Address - Street 2:KLUIN BLDG - SUITE 363
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141
Practice Address - Country:US
Practice Address - Phone:215-456-7000
Practice Address - Fax:215-455-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007706230139Medicaid
PA1007706230139Medicaid