Healthcare Provider Details

I. General information

NPI: 1811275936
Provider Name (Legal Business Name): SPINAL REHAB AND PAIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4723 PINE ST
PHILADELPHIA PA
19143-1831
US

IV. Provider business mailing address

4723 PINE ST
PHILADELPHIA PA
19143-1831
US

V. Phone/Fax

Practice location:
  • Phone: 267-292-3215
  • Fax: 267-292-3451
Mailing address:
  • Phone: 267-292-3215
  • Fax: 267-292-3451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD425455
License Number StatePA

VIII. Authorized Official

Name: DR. GENE LEVENSTEIN
Title or Position: CLINIC DIRECTOR
Credential: M.D., DABPM, DABPMR
Phone: 267-292-3215