Provider Demographics
NPI:1487382206
Name:TRISTATE PHYSICAL MEDICINE ASSOCIATES
Entity type:Organization
Organization Name:TRISTATE PHYSICAL MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:302-233-6916
Mailing Address - Street 1:1000 N WEST ST STE 1200
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-1058
Mailing Address - Country:US
Mailing Address - Phone:302-233-6916
Mailing Address - Fax:484-631-1315
Practice Address - Street 1:317 W GERMANTOWN PIKE STE 102
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4278
Practice Address - Country:US
Practice Address - Phone:302-233-6916
Practice Address - Fax:484-631-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty