Provider Demographics
NPI:1558391821
Name:GROSSINGER NEUROPAIN SPECIALISTS PC
Entity Type:Organization
Organization Name:GROSSINGER NEUROPAIN SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BLANCHE
Authorized Official - Middle Name:
Authorized Official - Last Name:DONATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-521-6063
Mailing Address - Street 1:1510 CHESTER PIKE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:EDDYSTONE
Mailing Address - State:PA
Mailing Address - Zip Code:19022-1375
Mailing Address - Country:US
Mailing Address - Phone:610-521-6063
Mailing Address - Fax:610-521-0163
Practice Address - Street 1:1510 CHESTER PIKE
Practice Address - Street 2:SUITE 130
Practice Address - City:EDDYSTONE
Practice Address - State:PA
Practice Address - Zip Code:19022-1375
Practice Address - Country:US
Practice Address - Phone:610-521-6063
Practice Address - Fax:610-521-0163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YP2500X, 2084N0400X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007731339-0002Medicaid
PACA8271Medicare PIN
PA051767P4RMedicare PIN