Provider Demographics
NPI:1093111916
Name:PAIN AND NEUROPATHY CENTER OF PA PC
Entity Type:Organization
Organization Name:PAIN AND NEUROPATHY CENTER OF PA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-431-6464
Mailing Address - Street 1:905 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:MATAMORAS
Mailing Address - State:PA
Mailing Address - Zip Code:18336-1541
Mailing Address - Country:US
Mailing Address - Phone:570-431-6464
Mailing Address - Fax:973-206-2236
Practice Address - Street 1:905 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:MATAMORAS
Practice Address - State:PA
Practice Address - Zip Code:18336-1541
Practice Address - Country:US
Practice Address - Phone:570-431-6464
Practice Address - Fax:973-206-2236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4235852081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty