Provider Demographics
NPI:1053007898
Name:CHOICE PAIN & REHABILITATION CENTER
Entity type:Organization
Organization Name:CHOICE PAIN & REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRISTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:224-347-4875
Mailing Address - Street 1:8843 GREENBELT RD STE 117
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2451
Mailing Address - Country:US
Mailing Address - Phone:240-786-1001
Mailing Address - Fax:
Practice Address - Street 1:100 BIDDLE AVE STE 101
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-3982
Practice Address - Country:US
Practice Address - Phone:302-392-3380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOICE PAIN & REHABILITATION CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty