Provider Demographics
NPI:1053515023
Name:PAIN AND SPINE TREATMENT CENTERS PC
Entity type:Organization
Organization Name:PAIN AND SPINE TREATMENT CENTERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:DWORKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-237-5006
Mailing Address - Street 1:1503 LANSDOWNE AVE
Mailing Address - Street 2:STE 2001
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023
Mailing Address - Country:US
Mailing Address - Phone:610-237-5006
Mailing Address - Fax:610-237-4138
Practice Address - Street 1:811 SUNSET RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016
Practice Address - Country:US
Practice Address - Phone:610-237-5006
Practice Address - Fax:610-237-4138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB047096002081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2182408Medicaid
NJ114936W05OtherPTAN
NJ1053515023Medicare UPIN
NJ114935Medicare PIN