Provider Demographics
NPI:1518216092
Name:PREMIER SPINE & PAIN MANAGEMENT PC
Entity Type:Organization
Organization Name:PREMIER SPINE & PAIN MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KANDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-438-5071
Mailing Address - Street 1:501 OMNI DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4528
Mailing Address - Country:US
Mailing Address - Phone:610-438-5071
Mailing Address - Fax:610-438-5073
Practice Address - Street 1:501 OMNI DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4528
Practice Address - Country:US
Practice Address - Phone:610-438-5071
Practice Address - Fax:610-438-5073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD439157208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA185251YFKOMedicare PIN