Provider Demographics
NPI:1710361936
Name:DROZ REHAB LLC
Entity Type:Organization
Organization Name:DROZ REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:HERNANDEZ
Authorized Official - Last Name:DROZDOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-840-4624
Mailing Address - Street 1:3115 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2901
Mailing Address - Country:US
Mailing Address - Phone:215-804-4624
Mailing Address - Fax:804-451-0535
Practice Address - Street 1:3115 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2901
Practice Address - Country:US
Practice Address - Phone:215-804-4624
Practice Address - Fax:804-451-0535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101256434208100000X
261QP3300X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4773539OtherAETNA
VA7044703OtherAETNA HMO BASED PLANS
VA1710361936OtherGROUP NPI