Provider Demographics
NPI:1790889103
Name:DREXEL UNIVERSITY
Entity Type:Organization
Organization Name:DREXEL UNIVERSITY
Other - Org Name:DREXEL GASTROENTEROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PAYER CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JANIEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-255-7766
Mailing Address - Street 1:1601 CHERRY ST
Mailing Address - Street 2:SUITE 11511
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1321
Mailing Address - Country:US
Mailing Address - Phone:215-255-7822
Mailing Address - Fax:215-255-7825
Practice Address - Street 1:219 N BROAD ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1519
Practice Address - Country:US
Practice Address - Phone:215-762-6220
Practice Address - Fax:215-762-5034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0238582000OtherIBC GROUP
NJ141402Medicare PIN
PA1007571110125Medicaid
PA020226Medicare PIN
PA381080OtherHIGHMARK PA BS GRP