Basic Information
| Provider Information | |||||||||
| NPI: | 1154592103 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROFESSIONAL PAIN MANAGMENT ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8890 | ||||||||
| Address2: | |||||||||
| City: | TURNERSVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080128890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567404888 | ||||||||
| FaxNumber: | 8567400559 | ||||||||
| Practice Location | |||||||||
| Address1: | 2007 N BLACK HORSE PIKE | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080949120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567404888 | ||||||||
| FaxNumber: | 8567400559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2008 | ||||||||
| LastUpdateDate: | 03/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | CORDA | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | DENNIS | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8567404888 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 25MB04459800 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.