Healthcare Provider Details

I. General information

NPI: 1538569561
Provider Name (Legal Business Name): DR. KEITH RADBILL PAIN MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 W. MAPLE AVE.
MERCHANTVILLE NJ
08109
US

IV. Provider business mailing address

602 W. MAPLE AVE.
MERCHANTVILLE NJ
08109
US

V. Phone/Fax

Practice location:
  • Phone: 856-375-1500
  • Fax: 609-482-8024
Mailing address:
  • Phone: 856-375-1500
  • Fax: 609-482-8024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB07528500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25MB07528500
License Number StateNJ

VIII. Authorized Official

Name: DR. KEITH RADBILL
Title or Position: OWNER
Credential: DO
Phone: 856-375-1500