Provider Demographics
NPI:1982818407
Name:GEORGE L. RODRIGUEZ, M.D., PC
Entity Type:Organization
Organization Name:GEORGE L. RODRIGUEZ, M.D., PC
Other - Org Name:INJURY REHABILITATION CENTERS OF PENNSYLVANIA /ADVANCED DIAGNOSTICS/UN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZILBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-425-1500
Mailing Address - Street 1:841 E ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-2401
Mailing Address - Country:US
Mailing Address - Phone:215-425-1500
Mailing Address - Fax:215-425-1659
Practice Address - Street 1:841 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-2401
Practice Address - Country:US
Practice Address - Phone:215-425-1500
Practice Address - Fax:215-425-1659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA045575900OtherINDEPENDENCE BLUE CROSS/PERSONAL CHOICE
PA626086 J1ZMedicare PIN