Provider Demographics
NPI:1639287311
Name:ALBERT EINSTEIN MEDICAL CENTER
Entity Type:Organization
Organization Name:ALBERT EINSTEIN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP. DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-456-6611
Mailing Address - Street 1:5501 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3018
Mailing Address - Country:US
Mailing Address - Phone:215-456-6611
Mailing Address - Fax:215-457-4304
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-6611
Practice Address - Fax:215-457-4304
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALBERT EINSTEIN HEALTHCARE NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-25
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA270601273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA39S142AMedicare ID - Type UnspecifiedPSYCH PROVIDER NUMBER