Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | OS017110 | PA |
NPI | 1467743344 |
---|---|
Provider Name | Justin Adam Pelberg |
First Address | Philadelphia, PA 19107-1500 |
Second Address | East Norriton, PA 19403-4243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2011 |
Last Update Date | 03/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1029247740003 | (05) | PA |