Basic Information
| Provider Information | |||||||||
| NPI: | 1952343345 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NOVA PAIN MANAGEMENT CENTERS LLC | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | NOVA SPINE AND PAIN CENTERS LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 285 DAVIDSON AVE | ||||||||
| Address2: | NOVA SPINE AND PAIN - SUITE 204 | ||||||||
| City: | SOMERSET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088734153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322711400 | ||||||||
| FaxNumber: | 7322713543 | ||||||||
| Practice Location | |||||||||
| Address1: | 285 DAVIDSON AVE | ||||||||
| Address2: | NOVA PAIN MANAGEMENT - SUITE 204 | ||||||||
| City: | SOMERSET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088734153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322711400 | ||||||||
| FaxNumber: | 7322713543 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 12/16/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TRONOLONE | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 7322711400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 25MA08612700 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8789606 | 05 | NJ | MEDICAID |