Provider Demographics
NPI:1831265222
Name:PROGRESSIVE PAIN SOLUTIONS LLC
Entity type:Organization
Organization Name:PROGRESSIVE PAIN SOLUTIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-863-8598
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:382 EPPS ST PROGRESSIVE PAIN SOLUTIONS LLC
Mailing Address - City:WIND GAP
Mailing Address - State:PA
Mailing Address - Zip Code:18091
Mailing Address - Country:US
Mailing Address - Phone:610-863-8598
Mailing Address - Fax:610-863-0267
Practice Address - Street 1:382 EPPS ST
Practice Address - Street 2:
Practice Address - City:WIND GAP
Practice Address - State:PA
Practice Address - Zip Code:18091
Practice Address - Country:US
Practice Address - Phone:610-863-8598
Practice Address - Fax:610-863-0267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA063184002081P2900X
PAMD056132L2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ002383Medicare ID - Type UnspecifiedINDIVID
PA056941Medicare ID - Type UnspecifiedGRP
PA777373Medicare ID - Type UnspecifiedINDIVID
NJ062394Medicare ID - Type UnspecifiedGRP
F90159Medicare UPIN