1639348840 NPI number — ROSEN HOFFBERG REHABILITATION AND PAIN MANAGEMENT ASSOCIATES PA

Table of content: (NPI 1639348840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639348840 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:
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:
1639348840
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8415 BELLONE LANE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21204-2066
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:
8415 BELLONE LANE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204-2066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-821-7775
Provider Business Practice Location Address Fax Number:
410-821-1320
Provider Enumeration Date:
02/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MARKOWITZ
Authorized Official First Name:
MARCIE
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY TREASURER
Authorized Official Telephone Number:
410-821-7775

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 89NXRO . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 404930600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 407861600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90TGRO . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 453648700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: K552RO . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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