Provider Demographics
NPI:1821059387
Name:CHRISTIANA SPINE CENTER PA
Entity Type:Organization
Organization Name:CHRISTIANA SPINE CENTER PA
Other - Org Name:PHYSIATRISTS ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-996-9522
Mailing Address - Street 1:4735 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 3302
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:302-623-4144
Mailing Address - Fax:302-623-4147
Practice Address - Street 1:4735 OGLETOWN STANTON RD STE 3302
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-623-4144
Practice Address - Fax:302-623-4147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0078028000OtherAMERIHEALTH
DE0000135302Medicaid
DE93388OtherAETNA
CL3148OtherRAILROAD MCR
DE25305OtherUNITED HC
DE93388OtherAETNA
DE=========OtherBCBSDE
DE=========OtherBCBSDE