Provider Demographics
NPI:1639496391
Name:TEMPLE PHYSICIANS INC
Entity Type:Organization
Organization Name:TEMPLE PHYSICIANS INC
Other - Org Name:TEMPLE PHYSICIANS @ PENNYPACK
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-926-9050
Mailing Address - Street 1:2726 HOLME AVE
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3011
Mailing Address - Country:US
Mailing Address - Phone:215-335-0130
Mailing Address - Fax:215-335-0653
Practice Address - Street 1:2726 HOLME AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19152-3011
Practice Address - Country:US
Practice Address - Phone:215-335-0130
Practice Address - Fax:215-335-0653
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEMPLE PHYSICIANS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-21
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA597586OtherMEDICARE GROUP
PACD4829OtherRR MEDICARE
PA597586OtherMEDICARE GROUP