Provider Demographics
NPI:1841613528
Name:SOUTHEAST PA PAIN MANAGEMENT, LTD
Entity Type:Organization
Organization Name:SOUTHEAST PA PAIN MANAGEMENT, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:SASSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-603-3139
Mailing Address - Street 1:PO BOX 826499
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-6499
Mailing Address - Country:US
Mailing Address - Phone:215-277-5888
Mailing Address - Fax:215-702-7075
Practice Address - Street 1:508 PRUDENTIAL RD STE 500
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2368
Practice Address - Country:US
Practice Address - Phone:855-235-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA16730690001Medicaid
PA16730690001Medicaid