Provider Demographics
NPI:1487657458
Name:FIERSTEIN, JEFFREY S (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:FIERSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9501 ROOSEVELT BLVD
Mailing Address - Street 2:STE 305
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1028
Mailing Address - Country:US
Mailing Address - Phone:215-671-4280
Mailing Address - Fax:215-464-9034
Practice Address - Street 1:261 OLD YORK RD
Practice Address - Street 2:STE 214
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3724
Practice Address - Country:US
Practice Address - Phone:215-885-4700
Practice Address - Fax:215-885-6861
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD021746E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000721484007Medicaid
PAB36323Medicare UPIN
PA000721484007Medicaid