Healthcare Provider Details

I. General information

NPI: 1609181502
Provider Name (Legal Business Name): UNITED PAIN MANAGEMENT OF SOUTH JERSEY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3071 E CHESTNUT AVE SUITE D-12
VINELAND NJ
08361-7847
US

IV. Provider business mailing address

PO BOX 872
BRIDGETON NJ
08302-0457
US

V. Phone/Fax

Practice location:
  • Phone: 800-529-9395
  • Fax: 856-451-8615
Mailing address:
  • Phone: 856-451-9395
  • Fax: 856-451-8615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID WATTS
Title or Position: PARTNER
Credential: MD
Phone: 800-529-9395