Provider Demographics
NPI:1689737710
Name:ADVANCED REHAB SPECIALIST. LLC
Entity Type:Organization
Organization Name:ADVANCED REHAB SPECIALIST. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:XIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-980-4622
Mailing Address - Street 1:240 MIDDLETOWN BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1832
Mailing Address - Country:US
Mailing Address - Phone:267-980-4622
Mailing Address - Fax:215-355-4315
Practice Address - Street 1:240 MIDDLETOWN BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1832
Practice Address - Country:US
Practice Address - Phone:267-980-4622
Practice Address - Fax:215-355-4315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418474174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1119123OtherAETNA
PA2620137000OtherINDEPENDENCE BLUE CROSS
PAAD1781750OtherHIGHMARK
PA17116OtherBRAVO
PAH62284Medicare UPIN
PA1119123OtherAETNA