Provider Demographics
NPI:1174676811
Name:PAIN MANAGEMENT AND REHABILITATION, PA
Entity Type:Organization
Organization Name:PAIN MANAGEMENT AND REHABILITATION, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GANESH
Authorized Official - Middle Name:R
Authorized Official - Last Name:BALU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-734-7246
Mailing Address - Street 1:71 HIDDEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7463
Mailing Address - Country:US
Mailing Address - Phone:302-733-0507
Mailing Address - Fax:302-733-7648
Practice Address - Street 1:240 BEISER BLVD
Practice Address - Street 2:SUITE 201B
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7790
Practice Address - Country:US
Practice Address - Phone:302-734-7246
Practice Address - Fax:302-678-8890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty