Basic Information
| Provider Information | |||||||||
| NPI: | 1063879971 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL PAIN AND WELLNESS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 725 MILL ST | ||||||||
| Address2: | |||||||||
| City: | MOORESTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080571803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098287443 | ||||||||
| FaxNumber: | 8563938481 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 MILL ST | ||||||||
| Address2: | |||||||||
| City: | MOORESTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080571803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098287443 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2016 | ||||||||
| LastUpdateDate: | 01/22/2016 | ||||||||
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| AuthorizedOfficialLastName: | BUCK | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6092907015 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | 25MA06131600 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.