Provider Demographics
NPI:1437555802
Name:RA PAIN SERVICES, P.A.
Entity Type:Organization
Organization Name:RA PAIN SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BURHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-727-2465
Mailing Address - Street 1:15000 MIDLANTIC DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1573
Mailing Address - Country:US
Mailing Address - Phone:856-255-5479
Mailing Address - Fax:856-393-8481
Practice Address - Street 1:1020 KINGS HWY N STE 106
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1906
Practice Address - Country:US
Practice Address - Phone:856-691-2211
Practice Address - Fax:856-691-2230
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:R.A.PAIN SERVICES, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-13
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06131600207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty