Provider Demographics
NPI:1285368175
Name:FREBEL, JACK (PA-C)
Entity type:Individual
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First Name:JACK
Middle Name:
Last Name:FREBEL
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1840 SOUTH ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-7411
Mailing Address - Country:US
Mailing Address - Phone:215-349-8310
Mailing Address - Fax:215-893-7270
Practice Address - Street 1:3400 SPRUCE STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4206
Practice Address - Country:US
Practice Address - Phone:215-349-8310
Practice Address - Fax:215-893-7270
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2025-07-22
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00794500363A00000X
PAMA063789363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant