Healthcare Provider Details

I. General information

NPI: 1407036767
Provider Name (Legal Business Name): PAC PROFESSIONAL PAIN MANAGEMENT, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 WHITEHORSE MERCERVILLE RD SUITE 310
HAMILTON NJ
08619-3810
US

IV. Provider business mailing address

PO BOX 8500-6796
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 609-581-6610
  • Fax:
Mailing address:
  • Phone: 201-804-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURENCE WIENER
Title or Position: OWNER
Credential:
Phone: 609-581-6610