Provider Demographics
NPI:1891733283
Name:GRADUATE HOSPITAL DEPT. OF MEDICINE EDUCATION & RESEARCH FOUNDATION
Entity Type:Organization
Organization Name:GRADUATE HOSPITAL DEPT. OF MEDICINE EDUCATION & RESEARCH FOUNDATION
Other - Org Name:JOHN J. WASNIEWSKI, JR. D.O.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:O
Authorized Official - Last Name:SETZLER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:215-893-7127
Mailing Address - Street 1:2136 W PASSYUNK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-3415
Mailing Address - Country:US
Mailing Address - Phone:215-271-0101
Mailing Address - Fax:215-334-7259
Practice Address - Street 1:2136 W PASSYUNK AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-3415
Practice Address - Country:US
Practice Address - Phone:215-271-0101
Practice Address - Fax:215-334-7259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
197661Medicare ID - Type Unspecified