| Organization Name: | NASPAC1-PRO LLC |
| NPI Number: | 1427427988 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIERAN SLEVIN (MEMBERS/MANAGERS) |
| Mailing Address: | 404 Creek Crossing Blvd Hainesport |
| State: | NJ US |
| Postal Code: | 080362768 |
| Phone Number: | 6098453988 |
| Fax Number: | 6092886078 |
| NPI Enumeration Date: | 09/15/2015 |
| NPI Last Update Date: | 09/15/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP3300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Pain |
| Taxonomy Definition: | |