Provider Demographics
NPI:1104852656
Name:ATLANTIC PAIN AND WELLNESS INSTITUTE PC
Entity Type:Organization
Organization Name:ATLANTIC PAIN AND WELLNESS INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-664-3000
Mailing Address - Street 1:27 WYNNEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1657
Mailing Address - Country:US
Mailing Address - Phone:610-664-3000
Mailing Address - Fax:610-664-3003
Practice Address - Street 1:333 E CITY LINE AVE STE PL20
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1507
Practice Address - Country:US
Practice Address - Phone:610-664-3000
Practice Address - Fax:610-664-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011370400002Medicaid
PA1011370400004Medicaid
PA1011370400003Medicaid
PA085839Medicare ID - Type Unspecified