Provider Demographics
NPI:1861512055
Name:CORE PEDIATRIC CARDIOLOGY, PC
Entity type:Organization
Organization Name:CORE PEDIATRIC CARDIOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZEV
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-616-4138
Mailing Address - Street 1:205 YORKTOWN PLZ
Mailing Address - Street 2:8120 OLD YORK ROAD
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1424
Mailing Address - Country:US
Mailing Address - Phone:610-616-4138
Mailing Address - Fax:
Practice Address - Street 1:205 YORKTOWN PLZ
Practice Address - Street 2:8120 OLD YORK ROAD
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1424
Practice Address - Country:US
Practice Address - Phone:610-616-4138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066670L2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty