Provider Demographics
NPI:1952853376
Name:KEYSTONE PAIN AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:KEYSTONE PAIN AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASIT
Authorized Official - Middle Name:P
Authorized Official - Last Name:UPADHYAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-718-9459
Mailing Address - Street 1:1600 6TH AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-2626
Mailing Address - Country:US
Mailing Address - Phone:717-718-9459
Mailing Address - Fax:717-718-9760
Practice Address - Street 1:1 LEMOYNE SQ
Practice Address - Street 2:SUITE 100
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1230
Practice Address - Country:US
Practice Address - Phone:717-718-9459
Practice Address - Fax:717-718-9760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-02
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-007929L2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001396610 0003Medicaid
PA444680Medicaid
PA001396610 0003Medicaid