1245552462 NPI number — REHABILITATION ASSOCIATES, P.A.

Table of content: (NPI 1245552462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245552462 NPI number — REHABILITATION ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHABILITATION ASSOCIATES, P.A.
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:
6
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:
1245552462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2006 FOULK RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19810-3644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-529-8783
Provider Business Mailing Address Fax Number:
302-529-1586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 N EAST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMYRNA
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19977-1413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-389-2225
Provider Business Practice Location Address Fax Number:
302-389-1003
Provider Enumeration Date:
02/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BAKST
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
302-529-8783

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CC5686 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 386606954 . This is a "BC/BS" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0632730 . This is a "AETNA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 147504 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2272852000 . This is a "AMERIHEALTH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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