Provider Demographics
NPI:1609181502
Name:UNITED PAIN MANAGEMENT OF SOUTH JERSEY PC
Entity Type:Organization
Organization Name:UNITED PAIN MANAGEMENT OF SOUTH JERSEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-529-9395
Mailing Address - Street 1:PO BOX 872
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-0457
Mailing Address - Country:US
Mailing Address - Phone:856-451-9395
Mailing Address - Fax:856-451-8615
Practice Address - Street 1:3071 E CHESTNUT AVE
Practice Address - Street 2:SUITE D-12
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-7847
Practice Address - Country:US
Practice Address - Phone:800-529-9395
Practice Address - Fax:856-451-8615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty