1679509160 NPI number — REHABILITATION ASSOCIATES, P.A.

Table of content: (NPI 1679509160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679509160 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:
DELAWARE BACK PAIN & SPORTS REHABILITATION CENTERS
Provider Other Organization Name Type Code:
3
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:
1679509160
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 BIDDLE AVE, SPRINGSIDE
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19702-3968
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:
2006 FOULK RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19810-3644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-529-8783
Provider Business Practice Location Address Fax Number:
302-529-1586
Provider Enumeration Date:
06/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WOLLASTON
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
302-529-8783

Provider Taxonomy Codes

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

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

  • Identifier: 2272852000 . This is a "AMERIHEATH-KEYSTONE" 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: 5707129 . This is a "AETNA PPO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0632730 . This is a "AETNA HMO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 386606954 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: CC5686 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1595337 . This is a "AMERIHEALTH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 26774 . This is a "COVENTRY" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 386606954CHI . This is a "BC/BS-CHIRO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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