Provider Demographics
NPI:1376089938
Name:INTEGRATIVE PAIN TREATMENT CENTER
Entity Type:Organization
Organization Name:INTEGRATIVE PAIN TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BINYAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-664-1391
Mailing Address - Street 1:954 MONTGOMERY AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072
Mailing Address - Country:US
Mailing Address - Phone:610-664-1391
Mailing Address - Fax:
Practice Address - Street 1:954 MONTGOMERY AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072
Practice Address - Country:US
Practice Address - Phone:610-664-1391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty