Healthcare Provider Details

I. General information

NPI: 1083271134
Provider Name (Legal Business Name): US FUNCTIONAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 E GATE DR STE C
MOUNT LAUREL NJ
08054-1238
US

IV. Provider business mailing address

813 E GATE DR STE C
MOUNT LAUREL NJ
08054-1238
US

V. Phone/Fax

Practice location:
  • Phone: 888-985-2727
  • Fax: 856-779-0211
Mailing address:
  • Phone: 888-985-2727
  • Fax: 856-779-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: YOUNG LEE
Title or Position: MBR
Credential: ME
Phone: 888-985-2727