Provider Demographics
NPI:1043031602
Name:JEFFERSON COMMUNITY PHYSICIANS
Entity type:Organization
Organization Name:JEFFERSON COMMUNITY PHYSICIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DANTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-238-7660
Mailing Address - Street 1:1200 OLD YORK RD FL BUERGER
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3720
Mailing Address - Country:US
Mailing Address - Phone:215-887-5934
Mailing Address - Fax:215-481-3481
Practice Address - Street 1:1200 OLD YORK RD FL BUERGER
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3720
Practice Address - Country:US
Practice Address - Phone:215-887-5934
Practice Address - Fax:215-481-3481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-17
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty