Provider Demographics
NPI:1891717922
Name:HELIOS INTERVENTIONAL PAIN SPECIALIST LLC
Entity Type:Organization
Organization Name:HELIOS INTERVENTIONAL PAIN SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-304-0226
Mailing Address - Street 1:211 SOUTH ST
Mailing Address - Street 2:SUITE 345
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-2305
Mailing Address - Country:US
Mailing Address - Phone:215-732-7600
Mailing Address - Fax:215-732-8656
Practice Address - Street 1:11 EVES DR
Practice Address - Street 2:SUITE 170
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3130
Practice Address - Country:US
Practice Address - Phone:856-797-9600
Practice Address - Fax:856-797-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2102577000OtherIBC
NJCJ8783Medicare PIN
NJ082020Medicare PIN
PA067169Medicare PIN