Provider Demographics
NPI:1124066030
Name:CENTER FOR PAIN MANAGEMENT AND ORTHOPAEDIC REHABILITATION INC
Entity type:Organization
Organization Name:CENTER FOR PAIN MANAGEMENT AND ORTHOPAEDIC REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COSENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-772-5556
Mailing Address - Street 1:800 E CYPRESS CREEK RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3522
Mailing Address - Country:US
Mailing Address - Phone:954-772-5556
Mailing Address - Fax:954-772-6254
Practice Address - Street 1:800 E CYPRESS CREEK RD
Practice Address - Street 2:SUITE 203
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-3522
Practice Address - Country:US
Practice Address - Phone:954-772-5556
Practice Address - Fax:954-772-6254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 67942081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8238Medicare ID - Type Unspecified