Provider Demographics
NPI:1871691212
Name:BROAD & JOSEPH ASSOCIATES
Entity Type:Organization
Organization Name:BROAD & JOSEPH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:T
Authorized Official - Last Name:BROAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-955-6526
Mailing Address - Street 1:1015 CHESTNUT ST
Mailing Address - Street 2:SUITE 916
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:215-955-6526
Mailing Address - Fax:215-925-3376
Practice Address - Street 1:1015 CHESTNUT ST
Practice Address - Street 2:SUITE 916
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-955-6526
Practice Address - Fax:215-925-3376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
028183Medicare ID - Type Unspecified
C29083Medicare UPIN