Phoenix Pain Relief Centers, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25MA04275000 Issued in NJ

Legal business name

PHOENIX PAIN RELIEF CENTERS, PA

Practice address

1000 Galloping Hill Rd
Suite 106
Union, NJ 07083-7989

Phone

(908) 378-5028

Fax

(908) 378-5796

NPI assigned

May 10, 2012

Organization subpart

No

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

Authorized official

Name

Rudolph Willis, MD

Title

Director

Phone

(908) 378-5028

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1336608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336608000000",
    "number": "1265791255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 GALLOPING HILL RD",
            "address_2": "SUITE 106",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "070837989",
            "telephone_number": "908-378-5028",
            "fax_number": "908-378-5796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 GALLOPING HILL RD",
            "address_2": "SUITE 106",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "070837989",
            "telephone_number": "908-378-5028",
            "fax_number": "908-378-5796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX PAIN RELIEF CENTERS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-10",
        "last_updated": "2012-05-10",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "RUDOLPH",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "908-378-5028",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA04275000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Perkins Union Center Pharmacy (Perkins Pharmacy)
• Personal Care at Home Inc.
• Demetria Petris, PHYSICAL THERAPIST
• Khanh Bao Phan, D.O.
• Clark E. Philogene, M.D.
• Colette B Pierce
• Jesse Pierre
• Sephorah Pierre
• Sara Jane Piersainvil
• Milagro Pina

• Family Medicine Physician in Union, NJ
• Providers in Union, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2012; 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.