Provider Demographics
NPI:1336171651
Name:NEMEZ, JACK SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:SAMUEL
Last Name:NEMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 KINDRED ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1724
Mailing Address - Country:US
Mailing Address - Phone:215-745-5662
Mailing Address - Fax:215-722-8722
Practice Address - Street 1:7001 KINDRED ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19149-1724
Practice Address - Country:US
Practice Address - Phone:215-745-5662
Practice Address - Fax:215-722-8722
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026922E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC29933Medicare UPIN
PA100066Medicare ID - Type Unspecified