Provider Demographics
NPI:1003212788
Name:RA PAIN SERVICES, P.A.
Entity Type:Organization
Organization Name:RA PAIN SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BURHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-727-2465
Mailing Address - Street 1:15000 MIDLANTIC DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1573
Mailing Address - Country:US
Mailing Address - Phone:856-255-5479
Mailing Address - Fax:856-393-8481
Practice Address - Street 1:329 GREENTREE RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9229
Practice Address - Country:US
Practice Address - Phone:856-228-7246
Practice Address - Fax:856-228-7252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-07
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06131600207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty