Provider Demographics
NPI:1962501684
Name:DELAWARE VALLEY PHYSIATRY, INC
Entity Type:Organization
Organization Name:DELAWARE VALLEY PHYSIATRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:BRICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-777-7898
Mailing Address - Street 1:4249 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-1913
Mailing Address - Country:US
Mailing Address - Phone:302-777-7898
Mailing Address - Fax:800-386-9828
Practice Address - Street 1:15 OMEGA DR
Practice Address - Street 2:BUILDING K
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2057
Practice Address - Country:US
Practice Address - Phone:302-777-7898
Practice Address - Fax:800-386-9828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000023526Medicaid
DE1000023526Medicaid