Provider Demographics
NPI:1083861264
Name:PAIN CONTROL PC
Entity type:Organization
Organization Name:PAIN CONTROL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVERBUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-953-9595
Mailing Address - Street 1:667 HENDRIX ST
Mailing Address - Street 2:BOX 11535
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-2031
Mailing Address - Country:US
Mailing Address - Phone:215-953-9595
Mailing Address - Fax:
Practice Address - Street 1:2 PARK LN
Practice Address - Street 2:SUITE 102
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6004
Practice Address - Country:US
Practice Address - Phone:215-240-1225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04914900207L00000X
PAMD032400E207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty