Provider Demographics
NPI:1932579950
Name:NEUROMED DIAGNOSTIC, PC
Entity Type:Organization
Organization Name:NEUROMED DIAGNOSTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:V
Authorized Official - Last Name:LEVENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-558-8778
Mailing Address - Street 1:1 N BACTON HILL RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:FRAZER
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1047
Mailing Address - Country:US
Mailing Address - Phone:877-558-8778
Mailing Address - Fax:
Practice Address - Street 1:1 N BACTON HILL RD
Practice Address - Street 2:SUITE 208
Practice Address - City:FRAZER
Practice Address - State:PA
Practice Address - Zip Code:19355-1047
Practice Address - Country:US
Practice Address - Phone:877-558-8778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4254552081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016843320001Medicaid
PAI29781Medicare UPIN
PA1016843320001Medicaid