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General NPI Number Information
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NPI Number | 1942735386
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Entity Type | Organization
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Legal Business Name | MEDICAL HEALING CENTER FOR PAIN
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Dates
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Enumeration Date | 04/24/2017
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 204 GROVE AVE STE C
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City | WEST DEPTFORD
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State | NJ
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Zip | 08086-2557
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Country | US
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Telephone | 856-537-6427
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Fax | 856-384-2726
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Provider Business Mailing Address
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Address Line | 204 GROVE AVE STE C
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City | WEST DEPTFORD
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State | NJ
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Zip | 08086-2557
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Country | US
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Telephone | 856-537-6427
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Fax | 856-384-2726
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Authorized Official
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Title or Position | CEO
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Name | SHANNIN DION LEWIS
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Credential | DO
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Telephone | 856-537-6427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 25MB09229100
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License Number State | NJ
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