Provider Information for 1104211648
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REHAB DIAGNOSTICS AND PAIN MEDICINE CENTER, LLC
Organization Subpart: NO
NPI: 1104211648
Last Updated: 2015-06-19
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||||
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| NPI | 1104211648 | ||||||||||||||||
| Enumeration Date | 2015-04-01 | ||||||||||||||||
| NPI Type | NPI-2 Organization | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Authorized Official Information | Name: Dr. YASSER GOUDA Title: Owner Phone: 2674286454 | ||||||||||||||||
| Mailing Address | 2121 N BROAD ST LANSDALE, PA 19446-1054 United States Phone: 267-428-6454 | Fax:267-428-6457 | ||||||||||||||||
| Primary Practice Address | 2121 N BROAD ST LANSDALE, PA 19446-1054 United States Phone: 267-428-6454 | Fax:267-428-6457 | ||||||||||||||||
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