Provider Demographics
NPI:1679222343
Name:PAIN AND SLEEP THERAPY CENTER LLC
Entity Type:Organization
Organization Name:PAIN AND SLEEP THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-299-5617
Mailing Address - Street 1:620 CHURCHMANS RD STE 203
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-1945
Mailing Address - Country:US
Mailing Address - Phone:302-299-5617
Mailing Address - Fax:
Practice Address - Street 1:1149 W LANCASTER AVE SPC U-5
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2722
Practice Address - Country:US
Practice Address - Phone:302-299-5617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty