Healthcare Provider Details

I. General information

NPI: 1558391821
Provider Name (Legal Business Name): GROSSINGER NEUROPAIN SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 CHESTER PIKE SUITE 130
EDDYSTONE PA
19022-1375
US

IV. Provider business mailing address

1510 CHESTER PIKE SUITE 130
EDDYSTONE PA
19022-1375
US

V. Phone/Fax

Practice location:
  • Phone: 610-521-6063
  • Fax: 610-521-0163
Mailing address:
  • Phone: 610-521-6063
  • Fax: 610-521-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: BLANCHE DONATO
Title or Position: OFFICE MANAGER
Credential:
Phone: 610-521-6063