Provider Demographics
NPI:1821431305
Name:CENTER FOR PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:CENTER FOR PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SARETA
Authorized Official - Middle Name:
Authorized Official - Last Name:COUBAROUS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:267-879-9260
Mailing Address - Street 1:1030 KINGS HWY N
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1907
Mailing Address - Country:US
Mailing Address - Phone:856-779-7774
Mailing Address - Fax:856-779-7787
Practice Address - Street 1:1030 KINGS HWY N
Practice Address - Street 2:SUITE 200A
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1907
Practice Address - Country:US
Practice Address - Phone:856-779-7774
Practice Address - Fax:856-779-7787
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITE SPINE AND PAIN PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB 080559002081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
152720Medicare UPIN