Organization
MAINLINE BODYBRAIN&SPINE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GINA MARIA BENAQUISTA DESIPIO D.O. (PRESIDENT)
(215) 284-0509
Entity
Organization
Contact information
Practice address
118 CONWAY AVE, NARBERTH, PA 19072-2202
(215) 284-0509
Mailing address
118 CONWAY AVE, NARBERTH, PA 19072-2202
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
OS015314
PA
2081P0004X
Spinal Cord Injury Medicine Physician
OS015314
PA
Other
Enumeration date
08/07/2014
Last updated
08/07/2014
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