Basic Information
| Provider Information | |||||||||
| NPI: | 1538520564 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL PAIN AND WELLNESS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 725 MILL ST | ||||||||
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| City: | MOORESTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080571803 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 34 SHEFFIELD DR | ||||||||
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| City: | MOORESTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080573091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562555479 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2016 | ||||||||
| LastUpdateDate: | 03/18/2016 | ||||||||
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| AuthorizedOfficialLastName: | BUCK | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8562555479 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25MB06402900 | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.