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General NPI Number Information
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NPI Number | 1992968937
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Entity Type | Organization
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Legal Business Name | STATE NEURODIAGNOSTICS AND PAIN MANAGMENT LLC
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Dates
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Enumeration Date | 07/09/2008
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Last Update Date | 12/02/2009
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Provider Practice Location Address
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Address Line | 6650 BROWNING RD SUITE U12
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City | PENNSAUKEN
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State | NJ
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Zip | 08109-1479
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Country | US
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Telephone | 856-910-1990
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Fax | 609-587-2277
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Provider Business Mailing Address
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Address Line | 111 COLFAX RD
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City | SKILLMAN
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State | NJ
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Zip | 08558
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Country | US
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Telephone | 267-265-6750
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Fax | 609-466-5494
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Authorized Official
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Title or Position | OWNER
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Name | BARRY D FASS
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Credential | MD
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Telephone | 267-265-6750
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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