Provider Demographics
NPI:1215934088
Name:JOHN HEINZ INSTITUTE OF REHABILITATION MEDICINE
Entity type:Organization
Organization Name:JOHN HEINZ INSTITUTE OF REHABILITATION MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CONABOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-348-1458
Mailing Address - Street 1:100 ABINGTON EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2258
Mailing Address - Country:US
Mailing Address - Phone:570-348-1364
Mailing Address - Fax:570-341-4646
Practice Address - Street 1:150 MUNDY ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6830
Practice Address - Country:US
Practice Address - Phone:570-826-3800
Practice Address - Fax:570-826-9108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA013701283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007644100005Medicaid
PA393036OtherLEGACY NUMBER
PA393036OtherLEGACY NUMBER
178364Medicare Oscar/Certification
PA415409Medicare Oscar/Certification