Healthcare Provider Details

I. General information

NPI: 1396802658
Provider Name (Legal Business Name): RA PAIN SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 GREENTREE RD
SEWELL NJ
08080-9229
US

IV. Provider business mailing address

329 GREENTREE RD
SEWELL NJ
08080-9229
US

V. Phone/Fax

Practice location:
  • Phone: 855-727-2465
  • Fax: 856-393-8691
Mailing address:
  • Phone: 855-727-2465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

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