Provider Demographics
NPI:1578002663
Name:ADVANCED PAIN SOLUTIONS OF PENNSYLVANIA LLC
Entity Type:Organization
Organization Name:ADVANCED PAIN SOLUTIONS OF PENNSYLVANIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASIT
Authorized Official - Middle Name:
Authorized Official - Last Name:UPADHYAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-718-9459
Mailing Address - Street 1:1 LEMOYNE SQ
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043
Mailing Address - Country:US
Mailing Address - Phone:717-718-9459
Mailing Address - Fax:717-718-9760
Practice Address - Street 1:1 LEMOYNE SQ
Practice Address - Street 2:SUITE 100
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043
Practice Address - Country:US
Practice Address - Phone:717-718-9459
Practice Address - Fax:717-718-9760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-007929L2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013966100003Medicaid
PA444680Medicaid
PA0013966100003Medicaid