Basic Information
| Provider Information | |||||||||
| NPI: | 1306843263 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROSEN-HOFFBERG REHABILITATION AND PAIN MANAGEMENT ASSOCIATES, PA | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 CROMWELL BRIDGE RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212863300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108217775 | ||||||||
| FaxNumber: | 4108211320 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 CROMWELL BRIDGE RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212863300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108217775 | ||||||||
| FaxNumber: | 4108211320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2005 | ||||||||
| LastUpdateDate: | 11/21/2016 | ||||||||
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| AuthorizedOfficialLastName: | PASQUA | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4108217775 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | D0011985 | MD | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 6563480001 | 01 | MD | MEDICARE DME | OTHER | 407861600 | 05 | MD | MEDICAID |