Provider Demographics
NPI:1942497078
Name:INSTITUTE FOR PAIN RELIEF PA
Entity Type:Organization
Organization Name:INSTITUTE FOR PAIN RELIEF PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAVITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-751-7799
Mailing Address - Street 1:33 FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2163
Mailing Address - Country:US
Mailing Address - Phone:856-344-2788
Mailing Address - Fax:
Practice Address - Street 1:2309 E EVESHAM RD
Practice Address - Street 2:SUITE B,C,D
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1559
Practice Address - Country:US
Practice Address - Phone:856-751-7799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ#25MB07408300207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ075851C60OtherMEDICARE ID
NJ0021466Medicaid
NJH98020Medicare UPIN