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General NPI Number Information
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NPI Number | 1346557469
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Entity Type | Organization
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Legal Business Name | PHOENIX PHYSICAL MEDICINE, P.C.
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Dates
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Enumeration Date | 09/10/2010
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Last Update Date | 09/10/2010
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Provider Practice Location Address
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Address Line | 701 WHITE HORSE RD SUITE 1
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City | VOORHEES
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State | NJ
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Zip | 08043-2494
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Country | US
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Telephone | 856-753-0581
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Fax | 856-753-0806
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Provider Business Mailing Address
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Address Line | 701 WHITE HORSE RD SUITE 1
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City | VOORHEES
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State | NJ
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Zip | 08043-2494
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Country | US
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Telephone | 856-753-0581
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Fax | 856-753-0806
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD LAWRENCE BRODY
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Credential | MD
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Telephone | 856-753-0581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 25MA06259100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 2MA06687200
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 2MA04660000
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License Number State | NJ
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