Provider Demographics
NPI:1205246576
Name:EINSTEIN PRACTICE PLAN, INC.
Entity type:Organization
Organization Name:EINSTEIN PRACTICE PLAN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-456-7000
Mailing Address - Street 1:5501 OLD YORK RD
Mailing Address - Street 2:KORMAN BUILDING, SUITE 202
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3018
Mailing Address - Country:US
Mailing Address - Phone:215-456-4694
Mailing Address - Fax:215-456-5926
Practice Address - Street 1:1200 W TABOR RD
Practice Address - Street 2:MOSS REHAB BUILDING, 4TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3019
Practice Address - Country:US
Practice Address - Phone:215-456-3815
Practice Address - Fax:215-456-6803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty