Provider Demographics
NPI:1396747531
Name:SOUTHEAST PA PAIN MANAGEMENT, LTD
Entity type:Organization
Organization Name:SOUTHEAST PA PAIN MANAGEMENT, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:SASSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-277-5888
Mailing Address - Street 1:508 PRUDENTIAL RD STE 500
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2309
Mailing Address - Country:US
Mailing Address - Phone:215-277-5888
Mailing Address - Fax:215-884-1066
Practice Address - Street 1:508 PRUDENTIAL RD STE 500
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2309
Practice Address - Country:US
Practice Address - Phone:215-277-5888
Practice Address - Fax:215-884-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1673069Medicaid
PA002358Medicare ID - Type Unspecified