MEDICARE: PAIN MANAGEMENT CENTER OF WEST ORANGE

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	208VP0014X	Interventional Pain Medicine Physician	ME0170989	FL

General Provider Information

NPI Number	:	1932347523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN MANAGEMENT CENTER OF WEST ORANGE

Provider Business Mailing Address
First Line	:	6000 METRO WEST BOULEVARD
Second Line	:	SUITE 101
City	:	ORLANDO
State	:	FL
Zip	:	32835-7630
Country	:	US
Telephone Number	:	407-345-1314
Fax Number	:	407-345-9788

Provider Business Practice Location Address
First Line	:	6000 METRO WEST BLVD.
Second Line	:	SUITE 101
City	:	ORLANDO
State	:	FL
Zip	:	32835-7630
Country	:	US
Telephone Number	:	407-345-1314
Fax Number	:	407-345-9788

Authorized Official
Title or Position	:	PAIN PHYSICIAN
Name	:	DR. CARLOS JASSIR
Credential	:	M.D.
Telephone Number	:	407-345-1314

Provider Enumeration Date	:	02/04/2009
Last Update Date	:	08/03/2010

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Directions to “PAIN MANAGEMENT CENTER OF WEST ORANGE ” Practice Location

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