Provider Demographics
NPI:1275564502
Name:PHYSIATRY MANAGEMENT SERVICES
Entity Type:Organization
Organization Name:PHYSIATRY MANAGEMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-261-5755
Mailing Address - Street 1:3111 ROUTE 38 BLDG#11
Mailing Address - Street 2:PMB 120
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-9754
Mailing Address - Country:US
Mailing Address - Phone:856-235-4828
Mailing Address - Fax:856-642-0238
Practice Address - Street 1:3111 ROUTE 38
Practice Address - Street 2:PMB 120
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9754
Practice Address - Country:US
Practice Address - Phone:856-235-4828
Practice Address - Fax:856-642-0238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ695306Medicare ID - Type Unspecified