Organization
ADVANCED PAIN CONSULTANTS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE JACKSON (ADMINISTRATIVE ASSISTANT)
(856) 489-9822
Entity
Organization
Contact information
Practice address
1 EXECUTIVE DRIVE, SUITE 430, MARLTON, NJ 08053-9572
(856) 489-9822
(856) 489-9877
Mailing address
1 EXECUTIVE DRIVE, SUITE 430, MARLTON, NJ 08053-9572
(856) 489-9822
(856) 489-9877
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
25MA06259700
NJ
208VP0014X
Interventional Pain Medicine Physician
25MB04736200
NJ
208VP0014X
Interventional Pain Medicine Physician
Primary
25MB04930000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001536163
HIGHMARK BLUE SHIELD ID
NJ
01
—
2221104000
AMERIHEALTH HMO ID
NJ
01
—
3311509
AETNA ID
NJ
Enumeration date
02/19/2007
Last updated
09/17/2024
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