Provider Demographics
NPI:1720074271
Name:JELEN, JOSEPH A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:JELEN
Suffix:JR
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 1:2701 HOLME AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2029
Mailing Address - Country:US
Mailing Address - Phone:215-335-3315
Mailing Address - Fax:215-333-7921
Practice Address - Street 1:2701 HOLME AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2029
Practice Address - Country:US
Practice Address - Phone:215-335-3315
Practice Address - Fax:215-333-7921
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022825E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAJE430760OtherPA BLUE SHIELD
PA30573OtherAETNA US HEALTHCARE
PA0009047240001Medicaid
PA0052427000OtherKEYSTONE HRE
PA30573OtherAETNA US HEALTHCARE
PA0009047240001Medicaid