Healthcare Provider Details

I. General information

NPI: 1003212788
Provider Name (Legal Business Name): RA PAIN SERVICES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2014
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 GREENTREE RD
SEWELL NJ
08080-9229
US

IV. Provider business mailing address

15000 MIDLANTIC DR SUITE 102
MOUNT LAUREL NJ
08054-1573
US

V. Phone/Fax

Practice location:
  • Phone: 856-228-7246
  • Fax: 856-228-7252
Mailing address:
  • Phone: 856-255-5479
  • Fax: 856-393-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25MA06131600
License Number StateNJ

VIII. Authorized Official

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