Provider Demographics
NPI:1306843263
Name:ROSEN-HOFFBERG REHABILITATION AND PAIN MANAGEMENT ASSOCIATES, PA
Entity Type:Organization
Organization Name:ROSEN-HOFFBERG REHABILITATION AND PAIN MANAGEMENT ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PASQUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-821-7775
Mailing Address - Street 1:1001 CROMWELL BRIDGE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-3300
Mailing Address - Country:US
Mailing Address - Phone:410-821-7775
Mailing Address - Fax:410-821-1320
Practice Address - Street 1:1001 CROMWELL BRIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3300
Practice Address - Country:US
Practice Address - Phone:410-821-7775
Practice Address - Fax:410-821-1320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-06
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0011985174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6563480001OtherMEDICARE DME
MD407861600Medicaid
MD407861600Medicaid
MD6563480001OtherMEDICARE DME