# MODERN SPINE AND PAIN PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174240352
- **Authorized official:** JOSEPHINE PRIBBLE (CREDENTIALING)
- **Authorized official phone:** (484) 394-2794

## Contact information

- **Practice address:** 196 GROVE AVE STE E, WEST DEPTFORD, NJ 08086-2139
- **Practice address phone:** (856) 900-0041
- **Mailing address:** PO BOX 358, DOUGLASSVILLE, PA 19518-0358

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | — | NULL | — |
| 174400000X | Specialist | — | — | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |
| 208VP0000X | Pain Medicine Physician | — | NULL | Yes |
| 208VP0000X | Pain Medicine Physician | — | — | Yes |
| 208VP0014X | Interventional Pain Medicine Physician | — | NULL | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 10/27/2022
- **Last updated:** 10/01/2026