Provider Demographics
NPI:1801963343
Name:JEFFERSON HEALTH - NORTHEAST
Entity type:Organization
Organization Name:JEFFERSON HEALTH - NORTHEAST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GALUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-612-5038
Mailing Address - Street 1:PO BOX 781001
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-1001
Mailing Address - Country:US
Mailing Address - Phone:215-481-6873
Mailing Address - Fax:215-481-3985
Practice Address - Street 1:10800 KNIGHTS RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-4200
Practice Address - Country:US
Practice Address - Phone:215-612-4000
Practice Address - Fax:215-710-3731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA061801282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001010000OtherPERSONAL CHOICE
NJ4193300OtherMEDICAID OF NEW JERSEY
PA0001010000OtherKEYSTONE IBC
PA390115BOtherCCN
PA0073204903OtherAMERICHOICE
PA1007705250011Medicaid
PA16465OtherHEALTH PARTNERS
PA120373OtherAETNA HMO
PA60086OtherKEYSTONE MERCY
PA6490865OtherAETNA PPO
PA=========007OtherCHAMPUS
PA120373OtherAETNA HMO