1841748324 NPI number — PAIN MANAGEMENT OF BERKS COUNTY

Table of content: (NPI 1841748324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841748324 NPI number — PAIN MANAGEMENT OF BERKS COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAIN MANAGEMENT OF BERKS COUNTY
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:
1841748324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3933 PERKIOMEN AVE
Provider Second Line Business Mailing Address:
SUITE E1
Provider Business Mailing Address City Name:
READING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19606-2756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-779-9292
Provider Business Mailing Address Fax Number:
610-779-3937

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3933 PERKIOMEN AVE
Provider Second Line Business Practice Location Address:
SUITE E1
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19606-2756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-779-9292
Provider Business Practice Location Address Fax Number:
610-779-3937
Provider Enumeration Date:
09/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BORJA
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-779-4588

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  MD057525-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AK001180 . This is a "STATE LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: MSG004016 . This is a "STATE LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: MSG001568 . This is a "STATE LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: MSG001153 . This is a "STATE LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: MSG00541 . This is a "STATE LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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