Provider Demographics
NPI:1639421266
Name:WEINERMAN PAIN & WELLNESS
Entity Type:Organization
Organization Name:WEINERMAN PAIN & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MESSING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-988-9503
Mailing Address - Street 1:1617 JOHN F KENNEDY BLVD STE 1100
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1826
Mailing Address - Country:US
Mailing Address - Phone:215-988-9533
Mailing Address - Fax:215-988-9533
Practice Address - Street 1:1617 JOHN F KENNEDY BLVD STE 1100
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1826
Practice Address - Country:US
Practice Address - Phone:215-988-9503
Practice Address - Fax:215-988-9533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004236L208D00000X
PADC005975L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1639421266Medicaid