=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396802658
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RA PAIN SERVICES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2007
-----------------------------------------------------
Last Update Date | 09/20/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 329 GREENTREE RD
-----------------------------------------------------
City | SEWELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08080-9229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-727-2465
-----------------------------------------------------
Fax | 856-393-8691
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 329 GREENTREE RD
-----------------------------------------------------
City | SEWELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08080-9229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-727-2465
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN PARTNER
-----------------------------------------------------
Name | BURHAN HALEEM
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 855-727-2465
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------