Healthcare Provider Details

I. General information

NPI: 1376526780
Provider Name (Legal Business Name): JEFFERSON PAIN AND REHAB CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 CLAIRTON BLVD
PITTSBURGH PA
15236-2115
US

IV. Provider business mailing address

4735 CLAIRTON BLVD
PITTSBURGH PA
15236-2115
US

V. Phone/Fax

Practice location:
  • Phone: 412-885-5400
  • Fax: 412-885-1773
Mailing address:
  • Phone: 412-885-5400
  • Fax: 412-885-1773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD037447Y
License Number StatePA

VIII. Authorized Official

Name: JOHN KEUN-SANG LEE
Title or Position: MEDICAL DIR JEFFERSON PAIN & REHAB
Credential: MD
Phone: 412-885-5400