Provider Demographics
NPI:1518174630
Name:ALBERT EINSTEIN MEDICAL CENTER
Entity Type:Organization
Organization Name:ALBERT EINSTEIN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC RESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA-RICARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-456-3436
Mailing Address - Street 1:2967 W SCHOOL HOUSE LN
Mailing Address - Street 2:APT C 1003
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-5222
Mailing Address - Country:US
Mailing Address - Phone:267-979-6626
Mailing Address - Fax:
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:PALEY BLDG, 1ST FLOOR. PEDIATRIC AND ADOLESCENT MEDICIN
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-7170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT 188183390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty