Provider Demographics
NPI:1811053556
Name:PHILADELPHIA FERTILITY INSTITUTE
Entity type:Organization
Organization Name:PHILADELPHIA FERTILITY INSTITUTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOCIAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-834-1230
Mailing Address - Street 1:815 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5504
Mailing Address - Country:US
Mailing Address - Phone:215-922-2206
Mailing Address - Fax:
Practice Address - Street 1:815 LOCUST ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5504
Practice Address - Country:US
Practice Address - Phone:215-922-2206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
Not Answered207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE69160Medicare UPIN
PAD98418Medicare UPIN
PAD16340Medicare UPIN
PAD71335Medicare UPIN