State Neurodiagnostics and Pain Managment LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

STATE NEURODIAGNOSTICS AND PAIN MANAGMENT LLC

Practice address

6650 Browning Rd
Suite U12
Pennsauken, NJ 08109-1479

Phone

(856) 910-1990

Fax

(609) 587-2277

NPI assigned

Jul 9, 2008

Organization subpart

No

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

Authorized official

Name

Barry D Fass, MD

Title

Owner

Phone

(267) 265-6750

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1215561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259712000000",
    "number": "1992968937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 COLFAX RD",
            "city": "SKILLMAN",
            "state": "NJ",
            "postal_code": "08558",
            "telephone_number": "267-265-6750",
            "fax_number": "609-466-5494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6650 BROWNING RD",
            "address_2": "SUITE U12",
            "city": "PENNSAUKEN",
            "state": "NJ",
            "postal_code": "081091479",
            "telephone_number": "856-910-1990",
            "fax_number": "609-587-2277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE NEURODIAGNOSTICS AND PAIN MANAGMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-09",
        "last_updated": "2009-12-02",
        "status": "A",
        "authorized_official_last_name": "FASS",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "267-265-6750",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Medicine & Rehabilitation Physician in Pennsauken, NJ
• Providers in Pennsauken, NJ by specialty
• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.