Provider Demographics
NPI:1003086075
Name:DIAGNOSTIC PAIN MEDICINE LLC
Entity type:Organization
Organization Name:DIAGNOSTIC PAIN MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-983-0779
Mailing Address - Street 1:73 N MAPLE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1782
Mailing Address - Country:US
Mailing Address - Phone:856-983-0779
Mailing Address - Fax:856-428-5235
Practice Address - Street 1:73 N MAPLE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1782
Practice Address - Country:US
Practice Address - Phone:856-983-0779
Practice Address - Fax:856-428-5235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04287100207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3426389000OtherINDEPENDENCE PERSONAL CHOICE
NJ9987137OtherAETNA PPO
NJ3426389000OtherKEYSTONE HEALTHPLAN EAST
NJ3426389000OtherAMERIHEALTH
NJ1791087OtherAETNA HMO