Provider Demographics
NPI:1447634050
Name:OASIS INTERVENTIONAL SPINE CARE, LLC
Entity type:Organization
Organization Name:OASIS INTERVENTIONAL SPINE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-462-4505
Mailing Address - Street 1:725 SKIPPACK PIKE
Mailing Address - Street 2:SUITE #130
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1741
Mailing Address - Country:US
Mailing Address - Phone:267-462-4505
Mailing Address - Fax:267-462-4504
Practice Address - Street 1:725 SKIPPACK PIKE
Practice Address - Street 2:SUITE #130
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1741
Practice Address - Country:US
Practice Address - Phone:267-462-4505
Practice Address - Fax:267-462-4504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD441402208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty