Provider Demographics
NPI:1467743344
Name:PELBERG, JUSTIN ADAM
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ADAM
Last Name:PELBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N BROAD ST FL 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1500
Mailing Address - Country:US
Mailing Address - Phone:267-479-4142
Mailing Address - Fax:215-463-3820
Practice Address - Street 1:609 W GERMANTOWN PIKE STE 120
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4243
Practice Address - Country:US
Practice Address - Phone:610-279-1370
Practice Address - Fax:610-279-1372
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS017110207RA0001X
PAOT013970207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029247740003Medicaid