Provider Demographics
NPI:1346557469
Name:PHOENIX PHYSICAL MEDICINE, P.C.
Entity Type:Organization
Organization Name:PHOENIX PHYSICAL MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:BRODY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-753-0581
Mailing Address - Street 1:701 WHITE HORSE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2494
Mailing Address - Country:US
Mailing Address - Phone:856-753-0581
Mailing Address - Fax:856-753-0806
Practice Address - Street 1:701 WHITE HORSE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2494
Practice Address - Country:US
Practice Address - Phone:856-753-0581
Practice Address - Fax:856-753-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2MA04660000208100000X
NJ25MA06259100208100000X
NJ2MA06687200208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty