Provider Demographics
NPI:1689755704
Name:PACIFIC PHYSICAL MEDICINE ASSOCIATES LLP
Entity Type:Organization
Organization Name:PACIFIC PHYSICAL MEDICINE ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:CROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-531-7277
Mailing Address - Street 1:1380 LUSITANA ST
Mailing Address - Street 2:SUITE 608
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2421
Mailing Address - Country:US
Mailing Address - Phone:808-531-7277
Mailing Address - Fax:808-531-7207
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 805
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-531-7277
Practice Address - Fax:808-531-7207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI253241Medicaid
HIH51459Medicare PIN