Organization
SUSQUEHANNA VALLEY PAIN MANAGEMENT PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALIK N MOMIN (PRESIDENT)
(717) 652-8670
Entity
Organization
Contact information
Practice address
825 SIR THOMAS CT, SUITE B, HARRISBURG, PA 17109
(717) 652-8670
(717) 901-5009
Mailing address
825 SIR THOMAS CT, SUITE B, HARRISBURG, PA 17109
(717) 652-8670
(717) 901-5009
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018860300004
—
PA
Enumeration date
01/06/2006
Last updated
01/06/2010
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