Provider Demographics
NPI:1952365595
Name:NE REHAB & PAIN MANAGEMENT CENTER
Entity Type:Organization
Organization Name:NE REHAB & PAIN MANAGEMENT CENTER
Other - Org Name:MRI DIAGNOSTIC IMAGING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-420-1955
Mailing Address - Street 1:230 INDEPENDENCE RD
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-9447
Mailing Address - Country:US
Mailing Address - Phone:570-420-1955
Mailing Address - Fax:570-424-0707
Practice Address - Street 1:230 INDEPENDENCE RD
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-9447
Practice Address - Country:US
Practice Address - Phone:570-420-1955
Practice Address - Fax:570-424-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014216420003Medicaid
PA0014216420003Medicaid