Provider Demographics
NPI:1619103025
Name:CHERRY HILL PAIN MANAGEMENT & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:CHERRY HILL PAIN MANAGEMENT & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMPROU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-433-8267
Mailing Address - Street 1:2070 SPRINGDALE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2043
Mailing Address - Country:US
Mailing Address - Phone:856-433-8267
Mailing Address - Fax:856-375-2251
Practice Address - Street 1:2070 SPRINGDALE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003
Practice Address - Country:US
Practice Address - Phone:856-433-8267
Practice Address - Fax:856-375-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA43012207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE61098Medicare UPIN