Basic Information
| Provider Information | |||||||||
| NPI: | 1871031666 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PA REHAB ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 375 E ELM ST | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | CONSHOHOCKEN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194281973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9083709104 | ||||||||
| FaxNumber: | 4842127641 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 LANSDOWNE AVE | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | DARBY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190231333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4844948646 | ||||||||
| FaxNumber: | 4844940226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2017 | ||||||||
| LastUpdateDate: | 02/01/2017 | ||||||||
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| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | NIRALI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9083709104 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHARMD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | MD042916L | PA | Y | Suppliers | Non-Pharmacy Dispensing Site |
No ID Information.