Healthcare Provider Details

I. General information

NPI: 1477943967
Provider Name (Legal Business Name): ALL CITY PAIN MANAGEMENT P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 SILLECK ST SUITE C
CLIFTON NJ
07013-1233
US

IV. Provider business mailing address

51 SILLECK ST SUITE C
CLIFTON NJ
07013-1233
US

V. Phone/Fax

Practice location:
  • Phone: 973-782-5811
  • Fax:
Mailing address:
  • Phone: 973-782-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00703500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number28MA008569300
License Number StateNJ

VIII. Authorized Official

Name: DR. CLIFTON BURT
Title or Position: PAIN MANAGEMENT DOCTOR
Credential: MD
Phone: 973-782-5811