Provider Demographics
NPI:1871712869
Name:REHAB PARTNERS IN PAIN MANAGEMENT
Entity type:Organization
Organization Name:REHAB PARTNERS IN PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIBILIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-281-3590
Mailing Address - Street 1:110 MARTER AVE
Mailing Address - Street 2:SUITE 412
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3124
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 MARTER AVE
Practice Address - Street 2:SUITE 412
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3124
Practice Address - Country:US
Practice Address - Phone:732-281-3590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06921900208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8070903Medicaid
=========OtherTAX ID/ EIN
NJG62532Medicare UPIN
=========OtherTAX ID/ EIN