Healthcare Provider Details

I. General information

NPI: 1700233905
Provider Name (Legal Business Name): RA PAIN SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 NEW RD
LINWOOD NJ
08221-1036
US

IV. Provider business mailing address

110 HARBOR LN SUITE A
SOMERS POINT NJ
08244-2470
US

V. Phone/Fax

Practice location:
  • Phone: 609-703-5097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: BURHAN HALEEM
Title or Position: PHYSICIAN PARTNER
Credential:
Phone: 855-727-2465