MEDICARE: SPINAL REHAB AND PAIN CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician	MD425455	PA

General Provider Information

NPI Number	:	1811275936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINAL REHAB AND PAIN CENTER

Provider Business Mailing Address
First Line	:	4723 PINE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-1831
Country	:	US
Telephone Number	:	267-292-3215
Fax Number	:	267-292-3451

Provider Business Practice Location Address
First Line	:	4723 PINE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-1831
Country	:	US
Telephone Number	:	267-292-3215
Fax Number	:	267-292-3451

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

Provider Enumeration Date	:	07/22/2011
Last Update Date	:	07/22/2011

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