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General NPI Number Information
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NPI Number | 1215986880
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Entity Type | Organization
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Legal Business Name | PENNSYLVANIA PAIN MANAGEMENT, INC.
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 1251 S CEDAR CREST BLVD SUITE 203
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City | ALLENTOWN
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State | PA
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Zip | 18103-6205
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Country | US
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Telephone | 610-439-1662
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Fax | 610-439-8397
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Provider Business Mailing Address
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Address Line | 1251 S CEDAR CREST BLVD SUITE 203
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City | ALLENTOWN
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State | PA
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Zip | 18103-6205
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Country | US
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Telephone | 610-439-1662
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Fax | 610-439-8397
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | DR. KENNETH J CHOQUETTE
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Credential | D.O.
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Telephone | 610-439-1662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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