Provider Demographics
NPI:1841748324
Name:PAIN MANAGEMENT OF BERKS COUNTY
Entity type:Organization
Organization Name:PAIN MANAGEMENT OF BERKS COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BORJA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-779-4588
Mailing Address - Street 1:3933 PERKIOMEN AVE
Mailing Address - Street 2:SUITE E1
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-2756
Mailing Address - Country:US
Mailing Address - Phone:610-779-9292
Mailing Address - Fax:610-779-3937
Practice Address - Street 1:3933 PERKIOMEN AVE
Practice Address - Street 2:SUITE E1
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-2756
Practice Address - Country:US
Practice Address - Phone:610-779-9292
Practice Address - Fax:610-779-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057525-L261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAK001180OtherSTATE LICENSE
PAMSG004016OtherSTATE LICENSE
PAMSG001568OtherSTATE LICENSE
PAMSG001153OtherSTATE LICENSE
PAMSG00541OtherSTATE LICENSE
PA480948YHOYMedicare UPIN
PAAK001180OtherSTATE LICENSE
PA813173Medicare UPIN
PA459513ZR3UMedicare UPIN