Provider Demographics
NPI:1467902320
Name:REJUVENATIONS MEDICAL AND REHABILITATION PC
Entity Type:Organization
Organization Name:REJUVENATIONS MEDICAL AND REHABILITATION PC
Other - Org Name:REJUVENATIONS MEDICAL & REHAB PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT AND SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:H
Authorized Official - Last Name:SORKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-681-1550
Mailing Address - Street 1:1880 LIPPINCOTT RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-7925
Mailing Address - Country:US
Mailing Address - Phone:215-681-1550
Mailing Address - Fax:215-305-3300
Practice Address - Street 1:1880 LIPPINCOTT RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-7925
Practice Address - Country:US
Practice Address - Phone:215-681-1550
Practice Address - Fax:215-305-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005950L261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3162829Medicaid