Provider Demographics
NPI:1811275936
Name:SPINAL REHAB AND PAIN CENTER
Entity type:Organization
Organization Name:SPINAL REHAB AND PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DABPM, DABPMR
Authorized Official - Phone:267-292-3215
Mailing Address - Street 1:4723 PINE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1831
Mailing Address - Country:US
Mailing Address - Phone:267-292-3215
Mailing Address - Fax:267-292-3451
Practice Address - Street 1:4723 PINE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1831
Practice Address - Country:US
Practice Address - Phone:267-292-3215
Practice Address - Fax:267-292-3451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425455208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty