Healthcare Provider Details

I. General information

NPI: 1750914776
Provider Name (Legal Business Name): CENTER FOR REGENERATIVE THERAPY AND PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 JACK MARTIN BLVD STE 4
BRICK NJ
08724-7724
US

IV. Provider business mailing address

459 JACK MARTIN BLVD STE 4
BRICK NJ
08724-7724
US

V. Phone/Fax

Practice location:
  • Phone: 732-747-7077
  • Fax:
Mailing address:
  • Phone: 732-747-7077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KARYN KARECKY
Title or Position: OFFICE MANAGER
Credential:
Phone: 732-747-7077