Provider Demographics
NPI:1255409405
Name:THOMAS JEFFERSON UNIVERSITY HOSPITAL
Entity type:Organization
Organization Name:THOMAS JEFFERSON UNIVERSITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBARSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-955-9895
Mailing Address - Street 1:PO BOX 85009895
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-955-7106
Mailing Address - Fax:215-955-8732
Practice Address - Street 1:111 S 11TH ST
Practice Address - Street 2:2210 GIBBON BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4824
Practice Address - Country:US
Practice Address - Phone:215-955-7106
Practice Address - Fax:215-955-8732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA200801261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007571300057Medicaid