Healthcare Provider Details

I. General information

NPI: 1326033994
Provider Name (Legal Business Name): KOENIGSBERG & ASSOCIATES PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S BROAD ST
PHILADELPHIA PA
19145-3948
US

IV. Provider business mailing address

2222 S BROAD ST
PHILADELPHIA PA
19145-3948
US

V. Phone/Fax

Practice location:
  • Phone: 215-467-7212
  • Fax: 215-467-7216
Mailing address:
  • Phone: 215-467-7212
  • Fax: 215-467-7216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: DON A KOENIGSBERG
Title or Position: PRESIDENT
Credential: DO
Phone: 215-467-7212