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General NPI Number Information
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NPI Number | 1174676811
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT AND REHABILITATION, PA
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 240 BEISER BLVD SUITE 201B
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City | DOVER
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State | DE
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Zip | 19904-7790
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Country | US
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Telephone | 302-734-7246
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Fax | 302-678-8890
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Provider Business Mailing Address
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Address Line | 71 HIDDEN VALLEY DR
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City | NEWARK
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State | DE
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Zip | 19711-7463
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Country | US
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Telephone | 302-733-0507
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Fax | 302-733-7648
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GANESH R BALU
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Credential | M.D.
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Telephone | 302-734-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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