Healthcare Provider Details

I. General information

NPI: 1780678045
Provider Name (Legal Business Name): PAIN MEDICINE AND REHABILITATION SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N POINTE BLVD SUITE 115
LANCASTER PA
17601-4134
US

IV. Provider business mailing address

160 N POINTE BLVD SUITE 115
LANCASTER PA
17601-4134
US

V. Phone/Fax

Practice location:
  • Phone: 717-560-4480
  • Fax: 717-560-4485
Mailing address:
  • Phone: 717-560-4480
  • Fax: 717-560-4485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number05006774E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. RANDY A COHEN
Title or Position: DOCTOR
Credential: DO
Phone: 717-560-4480