Provider Demographics
NPI:1780678045
Name:PAIN MEDICINE AND REHABILITATION SPECIALISTS
Entity Type:Organization
Organization Name:PAIN MEDICINE AND REHABILITATION SPECIALISTS
Other - Org Name:CONESTOGA REHABILITATION ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-560-4480
Mailing Address - Street 1:160 N POINTE BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4134
Mailing Address - Country:US
Mailing Address - Phone:717-560-4480
Mailing Address - Fax:717-560-4485
Practice Address - Street 1:160 N POINTE BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4134
Practice Address - Country:US
Practice Address - Phone:717-560-4480
Practice Address - Fax:717-560-4485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05006774E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E30606Medicare UPIN
PA677182Medicare ID - Type Unspecified