Healthcare Provider Details

I. General information

NPI: 1295163343
Provider Name (Legal Business Name): NEW JERSEY INTERVENTIONAL PAIN MANAGEMENT CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CORNWALL DR
EAST BRUNSWICK NJ
08816-3311
US

IV. Provider business mailing address

3 CORNWALL DR
EAST BRUNSWICK NJ
08816-3311
US

V. Phone/Fax

Practice location:
  • Phone: 732-698-1000
  • Fax: 732-698-1008
Mailing address:
  • Phone: 732-698-1000
  • Fax: 732-698-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMIT POONIA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 732-952-5533