Provider Demographics
NPI:1942698436
Name:PAIN RELIEF CENTER OF SOUTH JERSEY LLC
Entity Type:Organization
Organization Name:PAIN RELIEF CENTER OF SOUTH JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD/RPH
Authorized Official - Phone:856-255-5479
Mailing Address - Street 1:1 APPLE ORCHARD ROAD 1
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057
Mailing Address - Country:US
Mailing Address - Phone:856-866-0711
Mailing Address - Fax:856-793-9050
Practice Address - Street 1:130 GAITHER DRIVE.
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054
Practice Address - Country:US
Practice Address - Phone:856-722-7000
Practice Address - Fax:866-202-7134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain