1881649416 NPI number — FOX CHASE PAIN MANAGEMENT ASSOCIATES, PC

Table of content: (NPI 1881649416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881649416 NPI number — FOX CHASE PAIN MANAGEMENT ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOX CHASE PAIN MANAGEMENT ASSOCIATES, PC
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:
1881649416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4979 OLD STREET RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
TREVOSE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19053-6222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-288-5601
Provider Business Mailing Address Fax Number:
267-288-5905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4979 OLD STREET RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
TREVOSE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19053-6222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-288-5601
Provider Business Practice Location Address Fax Number:
267-288-5905
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROSEN
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
MARK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
267-288-5601

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD034707E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: MD008053E , 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)

  • Identifier: 5561325 . This is a "USHC GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0698266000 . This is a "AMERIHEALTH GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0000755415 . This is a "BC/BS GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0698266000 . This is a "KEYSTONE GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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