Healthcare Provider Details

I. General information

NPI: 1972151207
Provider Name (Legal Business Name): NASPAC-NJ PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 MARYLAND RD STE 100
WILLOW GROVE PA
19090-1758
US

IV. Provider business mailing address

404 CREEK CROSSING BLVD STE 404
HAINESPORT NJ
08036-2768
US

V. Phone/Fax

Practice location:
  • Phone: 215-657-1315
  • Fax: 215-659-8964
Mailing address:
  • Phone: 609-845-3988
  • Fax: 609-288-6078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RENEE BOGDOL
Title or Position: DIRECTOR REVENUE CYCLE
Credential: AM
Phone: 609-845-3988