Healthcare Provider Details

I. General information

NPI: 1588851927
Provider Name (Legal Business Name): CENTER FOR PAIN MANAGEMENT AND REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 E MAIN ST
BRIDGEWATER NJ
08807-3341
US

IV. Provider business mailing address

635 E MAIN ST
BRIDGEWATER NJ
08807-3341
US

V. Phone/Fax

Practice location:
  • Phone: 908-231-1131
  • Fax: 908-231-1132
Mailing address:
  • Phone: 908-231-1131
  • Fax: 908-231-1132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberMA 073550
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberMA073550
License Number StateNJ

VIII. Authorized Official

Name: DR. QING TAI
Title or Position: PRESIDENT
Credential: MD, PH.D.
Phone: 908-231-1131