Provider Demographics
NPI:1487009767
Name:JEFFERSON UNIVERSITY PHYSICIANS OF NEW JERSEY, P.C.
Entity Type:Organization
Organization Name:JEFFERSON UNIVERSITY PHYSICIANS OF NEW JERSEY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:HRISTOS
Authorized Official - Middle Name:
Authorized Official - Last Name:RISTAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-955-9298
Mailing Address - Street 1:PO BOX 828937 SUITE 130
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-8937
Mailing Address - Country:US
Mailing Address - Phone:215-503-1240
Mailing Address - Fax:
Practice Address - Street 1:443 LAUREL OAK RD
Practice Address - Street 2:SUITE 130
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4419
Practice Address - Country:US
Practice Address - Phone:856-741-0122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ133V00000X, 363A00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty