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General NPI Number Information
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NPI Number | 1104352335
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Entity Type | Organization
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Legal Business Name | ADVANCED SPINE AND PAIN, LLC
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Dates
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Enumeration Date | 05/09/2017
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 2 8TH ST
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City | HAMMONTON
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State | NJ
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Zip | 08037-3347
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Country | US
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Telephone | 888-985-2727
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Fax | 484-212-7641
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Provider Business Mailing Address
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Address Line | 201 DEFENSE HWY STE 205
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7096
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Country | US
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Telephone | 443-221-4396
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DAMEAN WILLIAM FREAS
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Credential |
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Telephone | 410-571-2946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 25MA09802600
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License Number State | NJ
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