Provider Demographics
NPI:1821390923
Name:GREATER PHILADELPHIA PAIN MANAGEMENT CENTER P.C.
Entity type:Organization
Organization Name:GREATER PHILADELPHIA PAIN MANAGEMENT CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-957-5400
Mailing Address - Street 1:104 BAILEY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-4526
Mailing Address - Country:US
Mailing Address - Phone:215-962-6031
Mailing Address - Fax:215-957-5401
Practice Address - Street 1:2612 RHAWN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3415
Practice Address - Country:US
Practice Address - Phone:215-338-8555
Practice Address - Fax:215-338-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007401L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0081342000OtherKEYSTONE
PA416307OtherHIGHMARK
PA3341682OtherAETNA
PACIGNAOther1046273