Healthcare Provider Details

I. General information

NPI: 1043618390
Provider Name (Legal Business Name): THE INJURY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2014
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2487 GRANT AVE #89
PHILADELPHIA PA
19114-1004
US

IV. Provider business mailing address

PO BOX 1628
HORSHAM PA
19044-6628
US

V. Phone/Fax

Practice location:
  • Phone: 215-360-7419
  • Fax: 215-464-0174
Mailing address:
  • Phone: 215-830-9991
  • Fax: 215-830-0175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: SEAN COSENZA
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 215-830-9991