1992735278 NPI number — PHYSICIANS REHABILITATION ASSOCIATES P C

Table of content: DR. PRABHJOT KAUR GREWAL MD (NPI 1770748030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992735278 NPI number — PHYSICIANS REHABILITATION ASSOCIATES P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS REHABILITATION ASSOCIATES P C
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:
1992735278
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 41654
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19101-1654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-237-5006
Provider Business Mailing Address Fax Number:
610-237-4138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1503 LANSDOWNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DARBY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19023-1330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-237-5006
Provider Business Practice Location Address Fax Number:
610-237-4138
Provider Enumeration Date:
07/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEMON
Authorized Official First Name:
TINA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
610-237-4612

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001203080 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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