Healthcare Provider Details

I. General information

NPI: 1215526033
Provider Name (Legal Business Name): NEW JERSEY PAIN AND NEUROPATHY CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 PIERSON AVE STE 101
EDISON NJ
08837-3118
US

IV. Provider business mailing address

295 PIERSON AVE STE 101
EDISON NJ
08837-3118
US

V. Phone/Fax

Practice location:
  • Phone: 732-738-1800
  • Fax:
Mailing address:
  • Phone: 732-738-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS ZIMMEL
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 732-738-1800