Basic Information
| Provider Information | |||||||||
| NPI: | 1013320845 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ECHENBERG INSTITUTE FOR PELVIC AND SEXUAL PAIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 623 W UNION BLVD | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180183708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108680104 | ||||||||
| FaxNumber: | 6108680204 | ||||||||
| Practice Location | |||||||||
| Address1: | 430 W BROADWAY FL 2 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100123784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108680104 | ||||||||
| FaxNumber: | 6108680204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2014 | ||||||||
| LastUpdateDate: | 06/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | ECHENBERG | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6108680104 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 274043 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.