1841467388 NPI number — CORE PERFORMANCE AND REHABILITATION

Table of content: (NPI 1841467388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841467388 NPI number — CORE PERFORMANCE AND REHABILITATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORE PERFORMANCE AND REHABILITATION
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:
1841467388
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 74
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRLESS HILLS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19030-0074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-860-3623
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2981 GRANT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19114-1012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-860-3623
Provider Business Practice Location Address Fax Number:
215-860-3763
Provider Enumeration Date:
05/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
VOLPACCHIO
Authorized Official First Name:
KIM
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
215-860-3623

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC006032L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT008765E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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