Provider Demographics
NPI:1255516068
Name:BREAKTHROUGH PAIN MANAGEMENT PC
Entity type:Organization
Organization Name:BREAKTHROUGH PAIN MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEGAL CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKIND
Authorized Official - Suffix:
Authorized Official - Credentials:ESQUIRE
Authorized Official - Phone:856-474-7800
Mailing Address - Street 1:100 SPRINGDALE ROAD
Mailing Address - Street 2:A3 #228
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2028
Mailing Address - Country:US
Mailing Address - Phone:856-816-5005
Mailing Address - Fax:
Practice Address - Street 1:416 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004-2268
Practice Address - Country:US
Practice Address - Phone:856-767-1026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07355800261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain