Provider Demographics
NPI:1073580478
Name:RJK MEDICAL ASSOCIATES LTD
Entity Type:Organization
Organization Name:RJK MEDICAL ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:KREB
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:610-738-2480
Mailing Address - Street 1:8701D W CHESTER PIKE
Mailing Address - Street 2:C O CBS
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-1115
Mailing Address - Country:US
Mailing Address - Phone:610-734-0610
Mailing Address - Fax:610-734-0874
Practice Address - Street 1:915 OLD FERN HILL ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380
Practice Address - Country:US
Practice Address - Phone:610-738-2490
Practice Address - Fax:610-738-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA49468Medicare ID - Type Unspecified