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General NPI Number Information
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NPI Number | 1043517899
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Entity Type | Organization
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Legal Business Name | PENNSYLVANIA SPINE & HEADACHE CENTER, PC
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Dates
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Enumeration Date | 02/14/2011
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Last Update Date | 04/03/2015
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Provider Practice Location Address
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Address Line | 3 N 2ND ST STE 3
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City | PHILADELPHIA
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State | PA
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Zip | 19106-2208
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Country | US
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Telephone | 215-776-6404
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Fax |
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Provider Business Mailing Address
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Address Line | 760 W LINCOLN HWY
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City | EXTON
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State | PA
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Zip | 19341-2547
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Country | US
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Telephone | 610-716-1879
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRUCE LEVIN
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Credential |
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Telephone | 215-776-6404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number | MD041591E
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License Number State | PA
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