Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD010163E | PA |
NPI | 1023104544 |
---|---|
Provider Name | Dr. Joel B Jurnovoy |
First Address | Newtown Square, PA 19073 |
Second Address | Havertown, PA 19083-2738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0031679000 | 081671 IBC PROVIDER # (01) | PA |
AJ0294544 | DEA (01) | PA |
B35218 | (02) | PA |
MD010163E | LICENSE (01) | PA |