MEDICARE: PAIN MANAGEMENT OF NEW JERSEY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1548368525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN MANAGEMENT OF NEW JERSEY INC

Provider Business Mailing Address
First Line	:	PO BOX 135
Second Line	:
City	:	ORADELL
State	:	NJ
Zip	:	07649-0135
Country	:	US
Telephone Number	:	201-342-1205
Fax Number	:	201-342-1259

Provider Business Practice Location Address
First Line	:	590 NEWARK AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-2302
Country	:	US
Telephone Number	:	201-342-1205
Fax Number	:	201-342-1259

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALFRED MAURO
Credential	:	MD
Telephone Number	:	201-342-1205

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	08/30/2010

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