Provider Demographics
NPI:1811885726
Name:ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN
Entity type:Organization
Organization Name:ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRST YEAR RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALONZO
Authorized Official - Middle Name:LETO
Authorized Official - Last Name:TABADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-902-0926
Mailing Address - Street 1:451 RHAWN ST UNIT 204
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2454
Mailing Address - Country:US
Mailing Address - Phone:631-902-0926
Mailing Address - Fax:
Practice Address - Street 1:160 E ERIE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1011
Practice Address - Country:US
Practice Address - Phone:215-427-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental