Provider Demographics
NPI:1023177144
Name:JOSEPH J. PETERS INSTITUTE
Entity type:Organization
Organization Name:JOSEPH J. PETERS INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:HASKELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-701-1560
Mailing Address - Street 1:100 SOUTH BROAD STREET
Mailing Address - Street 2:17TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19110
Mailing Address - Country:US
Mailing Address - Phone:215-701-1560
Mailing Address - Fax:215-701-1572
Practice Address - Street 1:100 SOUTH BROAD STREET
Practice Address - Street 2:17TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19110
Practice Address - Country:US
Practice Address - Phone:215-701-1560
Practice Address - Fax:215-701-1572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 261QM0801X, 261QM0855X
PA117040251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007562120008Medicaid
PAW87100Medicare UPIN
PA574364Medicare ID - Type Unspecified