Provider Demographics
NPI:1881649416
Name:FOX CHASE PAIN MANAGEMENT ASSOCIATES, PC
Entity Type:Organization
Organization Name:FOX CHASE PAIN MANAGEMENT ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-288-5601
Mailing Address - Street 1:4979 OLD STREET RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6222
Mailing Address - Country:US
Mailing Address - Phone:267-288-5601
Mailing Address - Fax:267-288-5905
Practice Address - Street 1:4979 OLD STREET RD
Practice Address - Street 2:SUITE B
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6222
Practice Address - Country:US
Practice Address - Phone:267-288-5601
Practice Address - Fax:267-288-5905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034707E174400000X
PAMD008053E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5561325OtherUSHC GROUP
PA0698266000OtherAMERIHEALTH GROUP
PA0000755415OtherBC/BS GROUP
PA0698266000OtherKEYSTONE GROUP
PA000755415Medicare ID - Type UnspecifiedMEDICARE GPOUP
NJ082769Medicare ID - Type UnspecifiedMEDICARE NJ GROUP