Garden, Jack L

Garden, Jack L is an individual health care provider with primary practice located at 2422 S Broad St 1St Floor, Phila PA 19145-4418. He recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as his primary health care specialty. Garden, Jack L can be contacted via phone (215) 389-1748.

Contact Information

Primary practice address
2422 S Broad St 1St Floor Phila PA 19145-4418
Phone: (215) 389-1748
Fax: (215) 389-0604
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 25MA08143100 New Jersey
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X MD038681E Pennsylvania

Profile Details

NPI number 1356328108
LBN Legal business name Garden, Jack L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 22nd, 2005
Last updated Nov 21st, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356328108 NPPES
Pennsylvania MEDICAID 0011409460002

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