Provider Demographics
NPI:1871025924
Name:ABRAMSON CENTER FOR JEWISH LIFE MEDICAL GROUP
Entity type:Organization
Organization Name:ABRAMSON CENTER FOR JEWISH LIFE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WASSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-371-3000
Mailing Address - Street 1:1425 HORSHAM RD
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1320
Mailing Address - Country:US
Mailing Address - Phone:215-371-3000
Mailing Address - Fax:
Practice Address - Street 1:135 S BRYN MAWR AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3106
Practice Address - Country:US
Practice Address - Phone:215-371-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MADLYN AND LEONARD ABRAMSON CENTER FOR JEWISH LIFE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA39010OtherEVERCARE UNITED HEALTH
PA006341OtherINDEPENDENCE BLUE CROSS
PA391700OtherMEDICARE HOSPICE (CAHABA)
PA1007600910035Medicaid
PA1007600910039Medicaid
PA39010OtherEVERCARE UNITED HEALTH