Provider Demographics
NPI:1285099226
Name:INSPIRA JEFFERSON PHYSICIANS PC
Entity type:Organization
Organization Name:INSPIRA JEFFERSON PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:WAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-641-6612
Mailing Address - Street 1:1120 DELSEA DR N
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-1444
Mailing Address - Country:US
Mailing Address - Phone:856-507-2780
Mailing Address - Fax:
Practice Address - Street 1:509 N BROAD ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1617
Practice Address - Country:US
Practice Address - Phone:856-205-7070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
221292YBAWMedicare PIN