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Organization
MODERN SPINE AND PAIN PC
Active
Organization
MODERN SPINE AND PAIN PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPHINE PRIBBLE (CREDENTIALING)
(484) 394-2794
Entity
Organization
Contact information
Practice address
196 GROVE AVE STE E, WEST DEPTFORD, NJ 08086-2139
(856) 900-0041
Mailing address
PO BOX 358, DOUGLASSVILLE, PA 19518-0358
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
NULL
174400000X
Specialist
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
NULL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
208VP0000X
Pain Medicine Physician
Primary
—
NULL
208VP0000X
Pain Medicine Physician
Primary
—
—
208VP0014X
Interventional Pain Medicine Physician
—
NULL
208VP0014X
Interventional Pain Medicine Physician
—
—
Other
Enumeration date
10/27/2022
Last updated
10/01/2026
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