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General NPI Number Information
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NPI Number | 1104852656
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Entity Type | Organization
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Legal Business Name | ATLANTIC PAIN AND WELLNESS INSTITUTE PC
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 11/21/2023
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Provider Practice Location Address
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Address Line | 333 E CITY LINE AVE STE PL20
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1507
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Country | US
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Telephone | 610-664-3000
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Fax | 610-664-3003
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Provider Business Mailing Address
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Address Line | 27 WYNNEWOOD DR
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City | VOORHEES
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State | NJ
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Zip | 08043-1657
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Country | US
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Telephone | 610-664-3000
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Fax | 610-664-3003
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SANJAY GUPTA
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Credential | DO
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Telephone | 610-664-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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