Provider Demographics
NPI:1104363985
Name:PREVENTATIVE PAIN & WELLNESS OF LAFAYETTE HILL
Entity Type:Organization
Organization Name:PREVENTATIVE PAIN & WELLNESS OF LAFAYETTE HILL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-376-6100
Mailing Address - Street 1:1053 SAW MILL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1048
Mailing Address - Country:US
Mailing Address - Phone:914-376-6100
Mailing Address - Fax:914-231-6872
Practice Address - Street 1:606 GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1802
Practice Address - Country:US
Practice Address - Phone:914-376-6100
Practice Address - Fax:914-231-6872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty