=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891717922
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HELIOS INTERVENTIONAL PAIN SPECIALIST LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2006
-----------------------------------------------------
Last Update Date | 04/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11 EVES DR SUITE 170
-----------------------------------------------------
City | MARLTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08053-3130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-797-9600
-----------------------------------------------------
Fax | 856-797-9601
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 SOUTH ST SUITE 345
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19147-2305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-732-7600
-----------------------------------------------------
Fax | 215-732-8656
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ALAN F KWON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 267-304-0226
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------