Spine Pain Rehab, LLC

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

License

25MA06687200 Issued in NJ

Legal business name

SPINE PAIN REHAB, LLC

Practice address

701 White Horse Rd
Suite 1
Voorhees, NJ 08043-2494

Phone

(609) 581-2700

Fax

(609) 261-7199

NPI assigned

Dec 2, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jo Bowen

Title

Billing Manager

Phone

(609) 261-5755

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John A Yulo, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Metuchen, NJ
  • NPI 1821102054
  Medicare reassignment
• Lucille Esralew, CP

  • Clinical Neuropsychologist
  • Princeton, NJ
  • NPI 1104982271
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1259712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259712000000",
    "number": "1114255114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 154",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080530154",
            "telephone_number": "609-261-5755",
            "fax_number": "609-261-7199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 WHITE HORSE RD",
            "address_2": "SUITE 1",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080432494",
            "telephone_number": "609-581-2700",
            "fax_number": "609-261-7199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE PAIN REHAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-02",
        "last_updated": "2009-12-02",
        "status": "A",
        "authorized_official_last_name": "BOWEN",
        "authorized_official_first_name": "JO",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "609-261-5755"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "NJ",
            "license": "25MA06687200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NJ LICENSE",
            "identifier": "25MA06687200",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa F Souza, APRN,BC
• Nicole Sara Speechley
• Kelly Glenn Speich, MD
• Christa Spence, OTR/L
• Shae Caroline Spicer, MSN, APN, FNP-BC
• Talya R Spivack, MD
• Christian Michael Squillante, MD
• Sr-73 and Lakeside Avenue Operations LLC
• Rebecca Sragow, BCBA
• Prathiba Srinidhi, DMD

• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Voorhees, NJ
• Providers in Voorhees, NJ by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.