Provider Demographics
NPI:1760423602
Name:EASTERN APPROACH REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:EASTERN APPROACH REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, DC
Authorized Official - Phone:267-992-1338
Mailing Address - Street 1:10100 JAMISON AVE STE 222
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3832
Mailing Address - Country:US
Mailing Address - Phone:215-676-3870
Mailing Address - Fax:
Practice Address - Street 1:10100 JAMISON AVE STE 222
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3832
Practice Address - Country:US
Practice Address - Phone:215-676-3870
Practice Address - Fax:215-676-6856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC0074444L111N00000X
111N00000X, 225100000X
PAPT015799225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001614143OtherHIGHMARK BLUE SHIELD ID
PA001614143OtherHIGHMARK BLUE SHIELD ID