Healthcare Provider Details

I. General information

NPI: 1043206899
Provider Name (Legal Business Name): THE READING NECK AND SPINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 BROADCASTING RD
WYOMISSING PA
19610-3203
US

IV. Provider business mailing address

1270 BROADCASTING RD
WYOMISSING PA
19610-3203
US

V. Phone/Fax

Practice location:
  • Phone: 610-372-1140
  • Fax:
Mailing address:
  • Phone: 610-372-1140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPT002688E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberMD065781L
License Number StatePA

VIII. Authorized Official

Name: STEPHEN P BANCO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 610-372-1140