NPIMap

Individual provider Active NPI

Jack I Jallo, MD

  • Neurological Surgery Physician
  • Philadelphia, PA
National Provider Identifier
1720076706
Registry record updated Mar 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
MD048313L Issued in PA
Practice address
909 Walnut St
2ND Floor
Philadelphia, PA 19107-5211
Phone
(215) 955-7000
Fax
(215) 503-9170
NPI assigned
Oct 12, 2005
Last updated
Mar 12, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 25MA06897900 NJ
Neurological Surgery Physician 207T00000X C1-0013235 DE
Neurological Surgery Physician 207T00000X MD048313L PA Primary

Addresses

Primary practice location

909 Walnut St
2ND Floor
Philadelphia, PA 19107-5211

Mailing address

909 Walnut St FL 2
Philadelphia, PA 19107-5211

Other practice location 1

3 Crescent Dr Fl 3
Philadelphia, PA 19112-1016
Phone (215) 503-3321

Other practice location 2

445 Hurffville Crosskeys Rd Ste B16
Sewell, NJ 08080-2351
Phone (856) 256-7591

Other practice location 3

443 Laurel Oak Rd Ste 130
Voorhees, NJ 08043-4419
Phone (856) 741-0122

Other identifiers 2

IdentifierTypeStateIssuer
001634580MedicaidPA
7226608MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ, DE3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20031210000673 PA Practitioner - Neurosurgery 4284530296 Reassigns benefits to 2 organizations
I20100119000065 NJ Practitioner - Neurosurgery 4284530296 Reassigns benefits to 2 organizations
I20260317003110 DE Practitioner - Neurosurgery 4284530296 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Temple University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians
Jefferson University Physicians of New Jersey PCGroup PAC ID 9931325131, 117 clinicians

Practice addresses (Care Compare)

3706 Kennett Pike
Greenville, DE 19807-2157
Phone (302) 477-1991

443 Laurel Oak Rd
Voorhees, NJ 08043-4419

900 Walnut St 2ND Floor
Jeff Hosp for Neuro
Philadelphia, PA 19107-5191
Phone (215) 955-1234

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion413
Laminectomy or laminotomy (partial removal of spine bones)108

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C1-0013235DEMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prospect Health Access Network, Inc. CurrentSince Jan 15, 2024 Accepting new patients
Jefferson University Physicians of New Jersey, P.C. Neurological Surgery CurrentSince Jul 1, 2014 Accepting new patients
Prospect Health Access Network, Inc. CurrentSince Jan 15, 2024 Accepting new patients
Jefferson University Physicians Neurological Surgery CurrentSince Feb 2, 2026 Accepting new patients
Prospect Health Access Network, Inc. Current Accepting new patients
Kennedy Medical Group Practice P.C. CurrentSince Sep 1, 2024 Accepting new patients
Kennedy Medical Group Practice, P.C. CurrentSince Jun 15, 2021 Accepting new patients
Kennedy Medical Group Practice PC CurrentSince Sep 1, 2024 Accepting new patients
Jefferson University Physicians Past Accepting new patients
Thomas Jefferson University Hospitals Inc Past Accepting new patients
Kennedy Medical Group Practice P.C. Past Accepting new patients

Locations

3706 Kennett Pike
Wilmington, DE 19807
Phone (302) 477-1991

457 Haddonfield Rd
Ste 110
Cherry Hill, NJ 08002
Phone (856) 406-4091

73 N Maple Ave
Marlton, NJ 08053
Phone (856) 352-6660

73 N Maple Ave
Ste B
Marlton, NJ 08053
Phone (856) 596-0558

445 Hurffville Crosskeys Rd
Ste B16
Sewell, NJ 08080
Phone (856) 256-7591

443 Laurel Oak Rd
Ste 100
Voorhees, NJ 08043
Phone (215) 955-1000

443 Laurel Oak Rd
Ste 130
Voorhees, NJ 08043
Phone (856) 741-0122

30 Lawrence Rd
Ste 700
Broomall, PA 19008
Phone (484) 446-3660

1 Medical Center Blvd
Ste 220
Chester, PA 19013
Phone (610) 394-1889

1 Medical Center Blvd
Ste 301
Chester, PA 19013
Phone (610) 566-6744

100 W Sproul Rd
Ste 123
Springfield, PA 19064
Phone (610) 619-8281

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773273600000",
    "number": "1720076706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 WALNUT ST FL 2",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 WALNUT ST",
            "address_2": "2ND FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075211",
            "telephone_number": "215-955-7000",
            "fax_number": "215-503-9170"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3 Crescent Dr Fl 3",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191121016",
            "country_code": "US",
            "telephone_number": "215-503-3321",
            "fax_number": "215-503-7163",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "445 Hurffville Crosskeys Rd Ste B16",
            "address_purpose": "LOCATION",
            "city": "Sewell",
            "state": "NJ",
            "postal_code": "080802351",
            "country_code": "US",
            "telephone_number": "856-256-7591",
            "fax_number": "856-256-7595",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "443 Laurel Oak Rd Ste 130",
            "address_purpose": "LOCATION",
            "city": "Voorhees",
            "state": "NJ",
            "postal_code": "080434419",
            "country_code": "US",
            "telephone_number": "856-741-0122",
            "fax_number": "856-741-0121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JALLO",
        "first_name": "JACK",
        "middle_name": "I",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-12",
        "last_updated": "2026-03-12",
        "certification_date": "2026-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NJ",
            "license": "25MA06897900",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "DE",
            "license": "C1-0013235",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "PA",
            "license": "MD048313L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001634580",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7226608",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.