Provider Demographics
NPI:1508240193
Name:S.E. PA PAIN MANAGEMENT
Entity Type:Organization
Organization Name:S.E. PA PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:SASSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-603-3139
Mailing Address - Street 1:721 DRESHER RD
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2220
Mailing Address - Country:US
Mailing Address - Phone:855-235-7246
Mailing Address - Fax:215-702-7075
Practice Address - Street 1:820 TOWN CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1785
Practice Address - Country:US
Practice Address - Phone:855-235-7246
Practice Address - Fax:215-702-7075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA16730690001Medicaid
PA16730690001Medicaid