Provider Demographics
NPI:1477634871
Name:JEFFRY A. LINDENBAUM, D.O., PC
Entity Type:Organization
Organization Name:JEFFRY A. LINDENBAUM, D.O., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LINDENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:267-503-0130
Mailing Address - Street 1:301 OXFORD VALLEY RD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-7706
Mailing Address - Country:US
Mailing Address - Phone:267-503-0130
Mailing Address - Fax:267-503-0127
Practice Address - Street 1:301 OXFORD VALLEY RD
Practice Address - Street 2:SUITE 1000
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7706
Practice Address - Country:US
Practice Address - Phone:267-503-0130
Practice Address - Fax:267-503-0127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-003465-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00648197Medicaid
PA0012646760004Medicaid
PAI19245Medicare UPIN
PA023382Medicare ID - Type UnspecifiedGROUP ID
PA00648197Medicaid