Provider Demographics
NPI:1245356138
Name:PAIN MEDICINE & REHABILITATION SPECIALISTS
Entity type:Organization
Organization Name:PAIN MEDICINE & REHABILITATION SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-560-4480
Mailing Address - Street 1:160 N POINTE BLVD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4134
Mailing Address - Country:US
Mailing Address - Phone:717-560-4480
Mailing Address - Fax:
Practice Address - Street 1:160 N POINTE BLVD
Practice Address - Street 2:SUITE 113
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4134
Practice Address - Country:US
Practice Address - Phone:717-560-4480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA260376OtherHEALTHAMERICA
PA02856300OtherCAPITAL BC
PA8135929OtherCIGNA