Healthcare Provider Details

I. General information

NPI: 1023361946
Provider Name (Legal Business Name): PAIN AND NEUROPATHY CENTER OF PA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1592 ROUTE 739
DINGMANS FERRY PA
18328-3513
US

IV. Provider business mailing address

1592 ROUTE 739
DINGMANS FERRY PA
18328-3513
US

V. Phone/Fax

Practice location:
  • Phone: 856-534-3714
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. AJAY KUMAR
Title or Position: DOCTOR
Credential: M.D.
Phone: 973-971-3800