# STATE NEURODIAGNOSTICS AND PAIN MANAGMENT LLC

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

## Provider details

- **NPI number:** 1992968937
- **Authorized official:** BARRY D FASS MD (OWNER)
- **Authorized official phone:** (267) 265-6750

## Contact information

- **Practice address:** 6650 BROWNING RD, SUITE U12, PENNSAUKEN, NJ 08109-1479
- **Practice address phone:** (856) 910-1990
- **Practice address fax:** (609) 587-2277
- **Mailing address:** 111 COLFAX RD, SKILLMAN, NJ 08558
- **Mailing address phone:** (267) 265-6750
- **Mailing address fax:** (609) 466-5494

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |

## Other

- **Enumeration date:** 07/09/2008
- **Last updated:** 12/02/2009