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General NPI Number Information
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NPI Number | 1609181502
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Entity Type | Organization
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Legal Business Name | UNITED PAIN MANAGEMENT OF SOUTH JERSEY PC
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Dates
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Enumeration Date | 08/16/2010
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Last Update Date | 08/16/2010
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Provider Practice Location Address
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Address Line | 3071 E CHESTNUT AVE SUITE D-12
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City | VINELAND
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State | NJ
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Zip | 08361-7847
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Country | US
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Telephone | 800-529-9395
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Fax | 856-451-8615
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Provider Business Mailing Address
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Address Line | PO BOX 872
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City | BRIDGETON
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State | NJ
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Zip | 08302-0457
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Country | US
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Telephone | 856-451-9395
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Fax | 856-451-8615
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Authorized Official
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Title or Position | PARTNER
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Name | DAVID WATTS
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Credential | MD
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Telephone | 800-529-9395
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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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