Basic Information
| Provider Information | |||||||||
| NPI: | 1548368525 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PAIN MANAGEMENT OF NEW JERSEY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 135 | ||||||||
| Address2: | |||||||||
| City: | ORADELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076490135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013421205 | ||||||||
| FaxNumber: | 2013421259 | ||||||||
| Practice Location | |||||||||
| Address1: | 590 NEWARK AVE | ||||||||
| Address2: | |||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 073062302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013421205 | ||||||||
| FaxNumber: | 2013421259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 08/30/2010 | ||||||||
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| AuthorizedOfficialLastName: | MAURO | ||||||||
| AuthorizedOfficialFirstName: | ALFRED | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2013421205 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.