1962689984 NPI number — BACK PAIN CLINIC OF COLLINGSWOOD,INC.,P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962689984 NPI number — BACK PAIN CLINIC OF COLLINGSWOOD,INC.,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BACK PAIN CLINIC OF COLLINGSWOOD,INC.,P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962689984
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1262
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLMAWR
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08099-5262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-957-9595
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 N HADDON AVE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
HADDONFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08033-1753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-857-9595
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SCHIPSKE
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
856-857-9595

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  38MC00332500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5667526 PIN . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2939905 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0949448 GRP . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5974547 PIN . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0110676 GRP . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2360862 GRP . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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