Healthcare Provider Details

I. General information

NPI: 1437272267
Provider Name (Legal Business Name): PAINMED NJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 STATE ROUTE 18
EAST BRUNSWICK NJ
08816-1413
US

IV. Provider business mailing address

209 STATE ROUTE 18
EAST BRUNSWICK NJ
08816-1413
US

V. Phone/Fax

Practice location:
  • Phone: 732-249-3100
  • Fax: 732-249-7787
Mailing address:
  • Phone: 732-249-3100
  • Fax: 732-249-7787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25MA06865600
License Number StateNJ

VIII. Authorized Official

Name: LALITHA PIRATLA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 732-249-3100