Basic Information
| Provider Information | |||||||||
| NPI: | 1023499894 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROSEN-HOFFBERG REHABILITATION AND PAIN MANAGEMENT ASSOCIATES, P.A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8415 BELLONA LN | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212042055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108217775 | ||||||||
| FaxNumber: | 4108211320 | ||||||||
| Practice Location | |||||||||
| Address1: | 8415 BELLONA LN | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212042055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108217775 | ||||||||
| FaxNumber: | 4108211320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2015 | ||||||||
| LastUpdateDate: | 06/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | PASQUA | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4108217775 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ROSEN-HOFFBERG REHABILITATION AND PAIN MANAGEMENT ASSOCIATES, P.A | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 407861600 | 05 | MD | MEDICAID |