Provider Demographics
NPI:1003858705
Name:MEDREHAB AND SPINE ASSOCIATES
Entity Type:Organization
Organization Name:MEDREHAB AND SPINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:856-985-0800
Mailing Address - Street 1:525 ROUTE 73 S
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-9642
Mailing Address - Country:US
Mailing Address - Phone:856-985-0800
Mailing Address - Fax:856-985-6331
Practice Address - Street 1:525 ROUTE 73 S
Practice Address - Street 2:SUITE 103
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9642
Practice Address - Country:US
Practice Address - Phone:856-985-0800
Practice Address - Fax:856-985-6331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ010655STQMedicare ID - Type UnspecifiedDR. SORIANO
NJ097739STQMedicare ID - Type UnspecifiedDR. PAUL
NJG77601Medicare UPIN
NJ079935Medicare ID - Type UnspecifiedGROUP #
NJI48750Medicare UPIN