Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MT218305 | PA |
NPI | 1003477050 |
---|---|
Provider Name | Jennifer Bracken Imbriale |
First Address | Philadelphia, PA 19140-5103 |
Second Address | Philadelphia, PA 19140-5103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2019 |
Last Update Date | 20/06/2019 |