Provider Demographics
NPI:1053769489
Name:TEMPLE PHYSICIANS INC
Entity type:Organization
Organization Name:TEMPLE PHYSICIANS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEBANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-926-9022
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:2ND FLOOR TPI
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-926-9022
Mailing Address - Fax:
Practice Address - Street 1:10100 JAMISON AVE
Practice Address - Street 2:#227
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3832
Practice Address - Country:US
Practice Address - Phone:215-969-1404
Practice Address - Fax:215-969-1407
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEMPLE PHYSICIANS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty