Healthcare Provider Details

I. General information

NPI: 1821390923
Provider Name (Legal Business Name): GREATER PHILADELPHIA PAIN MANAGEMENT CENTER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2010
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2612 RHAWN ST
PHILADELPHIA PA
19152-3415
US

IV. Provider business mailing address

104 BAILEY DR
NORTH WALES PA
19454-4526
US

V. Phone/Fax

Practice location:
  • Phone: 215-338-8555
  • Fax: 215-338-8031
Mailing address:
  • Phone: 215-962-6031
  • Fax: 215-957-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC007401L
License Number StatePA

VIII. Authorized Official

Name: GENE LEVINSTEIN
Title or Position: PHYSICIAN
Credential: MD
Phone: 215-957-5400