Provider Demographics
NPI:1205904885
Name:JEFFERSON HEALTH - NORTHEAST
Entity type:Organization
Organization Name:JEFFERSON HEALTH - NORTHEAST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GALUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-612-5038
Mailing Address - Street 1:PO BOX 781001
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-1001
Mailing Address - Country:US
Mailing Address - Phone:215-481-6873
Mailing Address - Fax:215-481-3985
Practice Address - Street 1:380 OXFORD VALLEY RD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-8304
Practice Address - Country:US
Practice Address - Phone:215-949-5000
Practice Address - Fax:215-710-3731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA061801282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001010000OtherKEYSTONE, IBC
PA2072992OtherAETNA HMO
PA1007705250041Medicaid
PA0001010000OtherPERSONAL CHOICE
PA08277OtherHEALTH PARTNERS
NJ4193300OtherMEDICAID OF NEW JERSEY
PA60058OtherKEYSTONE MERCY
PA0073204904OtherAMERICHOICE
PA6491565OtherAETNA PPO
PA60058OtherKEYSTONE MERCY
PA60058OtherKEYSTONE MERCY