Basic Information
| Provider Information | |||||||||
| NPI: | 1528505765 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPREHENSIVE PAIN MANAGEMENT SPECIALIST, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 375 E ELM ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | CONSHOHOCKEN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194281973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9083709104 | ||||||||
| FaxNumber: | 4842127641 | ||||||||
| Practice Location | |||||||||
| Address1: | 1177 HIGHWAY 315 BLVD | ||||||||
| Address2: | |||||||||
| City: | WILKES BARRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187026928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702705712 | ||||||||
| FaxNumber: | 5702705719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2017 | ||||||||
| LastUpdateDate: | 01/26/2017 | ||||||||
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| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | NIRALI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9083709104 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHARMD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | OS006388E | PA | Y | Suppliers | Non-Pharmacy Dispensing Site |
No ID Information.