Mainline Bodybrain&Spine, P.C.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

OS015314 Issued in PA

Legal business name

MAINLINE BODYBRAIN&SPINE, P.C.

Practice address

118 Conway Ave
Narberth, PA 19072-2202

Phone

(215) 284-0509

NPI assigned

Aug 7, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gina Maria Benaquista Desipio, D.O.

Title

President

Phone

(215) 284-0509

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407369600000",
    "number": "1215346879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 CONWAY AVE",
            "city": "NARBERTH",
            "state": "PA",
            "postal_code": "190722202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 CONWAY AVE",
            "city": "NARBERTH",
            "state": "PA",
            "postal_code": "190722202",
            "telephone_number": "215-284-0509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAINLINE BODYBRAIN&SPINE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-07",
        "last_updated": "2014-08-07",
        "status": "A",
        "authorized_official_last_name": "BENAQUISTA DESIPIO",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "MARIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-284-0509",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "PA",
            "license": "OS015314",
            "primary": true
        },
        {
            "code": "2081P0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine",
            "state": "PA",
            "license": "OS015314",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Heidi Mandel, DPM

• Physical Medicine & Rehabilitation Physician in Narberth, PA
• Providers in Narberth, PA by specialty
• Physical Medicine & Rehabilitation Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.