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General NPI Number Information
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NPI Number | 1578748836
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Entity Type | Organization
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Legal Business Name | SOUTH JERSEY PAIN CONSULTANTS, LLC
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 525 ROUTE 73 S SUITE 103
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City | MARLTON
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State | NJ
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Zip | 08053-9642
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Country | US
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Telephone | 856-797-5777
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Fax | 856-797-5771
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Provider Business Mailing Address
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Address Line | 525 ROUTE 73 S SUITE 103
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City | MARLTON
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State | NJ
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Zip | 08053-9642
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Country | US
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Telephone | 856-797-5777
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Fax | 856-797-5771
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | MRS. MONICA M POWELL II
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Credential |
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Telephone | 856-797-5777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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