Eastern States Pain Specialists, LLC

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

Legal business name

EASTERN STATES PAIN SPECIALISTS, LLC

Practice address

15000 Midlantic Dr
Mount Laurel, NJ 08054-1573

Phone

(856) 855-5479

NPI assigned

Oct 7, 2015

Last updated

Oct 7, 2015By the provider in NPPES

Organization subpart

Yes

Parent organization

RA PAIN SERVICES, PAAs reported in NPPES

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

Authorized official

Name

Jeffrey Gordon, M.D.

Title

Authorized Official

Phone

(201) 667-5568

Specialties & licenses 1

Addresses

Tax ID family

Eastern States Pain Specialists Limited2 organizations share this tax ID, including this one

Part of

Ra Pain Services PA

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Eastern States Pain Specialists Limited

  • Interventional Pain Medicine Physician
  • Mount Laurel, NJ
  • NPI 1477937670
  NPD tax ID

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

{
    "created_epoch": "1444176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444176000000",
    "number": "1225409980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4604",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176044604",
            "telephone_number": "201-804-2800",
            "fax_number": "201-804-8883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15000 MIDLANTIC DR",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080541573",
            "telephone_number": "856-855-5479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN STATES PAIN SPECIALISTS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RA PAIN SERVICES, PA",
        "enumeration_date": "2015-10-07",
        "last_updated": "2015-10-07",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "201-667-5568",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dynamic Commerce Applications, Inc.
• Izabela Kinga Dziedzic
• East Gate Chiropractic & Wellness, LLC
• East Meets West Acupuncture
• Eastern States Pain Specialists Limited
• Eastern Therapeutics LLC
• Lauren Ebner
• Jessica Eckbold, BCBA
• Kathryn A Eckstein, D. C.
• Edmund J Decker DO PA

• Pain Medicine Physician in Mount Laurel, NJ
• Providers in Mount Laurel, NJ by specialty
• Pain Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.