Provider Demographics
NPI:1386039790
Name:S.E. PA PAIN MANAGEMENT
Entity type:Organization
Organization Name:S.E. PA PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FALL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-873-5415
Mailing Address - Street 1:721 DRESHER RD
Mailing Address - Street 2:2500
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2220
Mailing Address - Country:US
Mailing Address - Phone:215-873-5415
Mailing Address - Fax:
Practice Address - Street 1:721 DRESHER RD
Practice Address - Street 2:2500
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2220
Practice Address - Country:US
Practice Address - Phone:215-873-5415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site