1093096232 NPI number — ROSEN-HOFFBERG REHABILITATION AND PAIN MANAGEMENT ASSOCIATES, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093096232 NPI number — ROSEN-HOFFBERG REHABILITATION AND PAIN MANAGEMENT ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSEN-HOFFBERG REHABILITATION AND PAIN MANAGEMENT ASSOCIATES, PA
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:
Provider Other Organization Name Type Code:
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:
1093096232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 CROMWELL BRIDGE RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21286-2055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-821-7775
Provider Business Mailing Address Fax Number:
410-821-1320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10085 RED RUN BLVD
Provider Second Line Business Practice Location Address:
SUITE 404
Provider Business Practice Location Address City Name:
OWINGS MILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21117-4836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-363-7246
Provider Business Practice Location Address Fax Number:
410-363-0165
Provider Enumeration Date:
09/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PASQUA
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT TREASURER/OFFICE MANAGER
Authorized Official Telephone Number:
410-821-7775

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6563480002 . This is a "MEDICARE DME" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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