1568713832 NPI number — PAIN SOLUTION CENTERS OF DELAWARE

Table of content: (NPI 1568713832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568713832 NPI number — PAIN SOLUTION CENTERS OF DELAWARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAIN SOLUTION CENTERS OF DELAWARE
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:
1568713832
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1006
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENSALEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19020-5006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-750-9600
Provider Business Mailing Address Fax Number:
215-752-8568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 CHURCHMANS RD
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19702-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-750-9600
Provider Business Practice Location Address Fax Number:
267-332-0948
Provider Enumeration Date:
09/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FICCHI
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
215-750-9600

Provider Taxonomy Codes

  • Taxonomy code: 320700000X , with the licence number:  OS3881L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320700000X , with the licence number: C2-0010172 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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