Provider Demographics
NPI:1922731017
Name:ADVANCED SPINE AND PAIN LLC
Entity Type:Organization
Organization Name:ADVANCED SPINE AND PAIN LLC
Other - Org Name:RELIEVUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BRANDALYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-985-2727
Mailing Address - Street 1:813 E GATE DR STE B
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1238
Mailing Address - Country:US
Mailing Address - Phone:888-985-2727
Mailing Address - Fax:
Practice Address - Street 1:40 BEY LEA RD BLDG C
Practice Address - Street 2:STE 203
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2989
Practice Address - Country:US
Practice Address - Phone:888-985-2727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty