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General NPI Number Information
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NPI Number | 1093111916
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Entity Type | Organization
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Legal Business Name | PAIN AND NEUROPATHY CENTER OF PA PC
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Dates
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Enumeration Date | 11/05/2014
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 905 PENNSYLVANIA AVE
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City | MATAMORAS
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State | PA
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Zip | 18336-1541
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Country | US
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Telephone | 570-431-6464
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Fax | 973-206-2236
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Provider Business Mailing Address
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Address Line | 905 PENNSYLVANIA AVE
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City | MATAMORAS
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State | PA
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Zip | 18336-1541
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Country | US
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Telephone | 570-431-6464
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Fax | 973-206-2236
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AJAY KUMAR
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Credential | M.D.
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Telephone | 570-431-6464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | MD423585
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License Number State | PA
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