Provider Demographics
NPI:1851716781
Name:PRINCETON PAIN MANAGEMENT & WELLNESS, LLC
Entity Type:Organization
Organization Name:PRINCETON PAIN MANAGEMENT & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:WELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-442-7807
Mailing Address - Street 1:3100 PRINCETON PIKE
Mailing Address - Street 2:SUITE 1-I
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2300
Mailing Address - Country:US
Mailing Address - Phone:609-895-1030
Mailing Address - Fax:609-895-1032
Practice Address - Street 1:3100 PRINCETON PIKE
Practice Address - Street 2:SUITE 1-I
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2300
Practice Address - Country:US
Practice Address - Phone:609-895-1030
Practice Address - Fax:609-895-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-01
Last Update Date:2014-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07771400261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain