1013017219 NPI number — R & B MEDICAL MANAGEMENT, INC

Table of content: (NPI 1013017219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013017219 NPI number — R & B MEDICAL MANAGEMENT, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R & B MEDICAL MANAGEMENT, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INDUSTRIAL HEALTHCARE CENTER
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013017219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E LEHIGH AVE
Provider Second Line Business Mailing Address:
MAB SUITE L06
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19125-1012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-291-3056
Provider Business Mailing Address Fax Number:
215-425-1487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 E ALLEGHENY AVE
Provider Second Line Business Practice Location Address:
NORTHEASTERN HOSPITAL
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19134-4427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-291-3056
Provider Business Practice Location Address Fax Number:
215-425-1487
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHADE
Authorized Official First Name:
KRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL COORDINATOR/OFFICE MANAGER
Authorized Official Telephone Number:
215-291-3059

Provider Taxonomy Codes

  • Taxonomy code: 261QX0100X , with the licence number:  MD036450L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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