Healthcare Provider Details

I. General information

NPI: 1972820041
Provider Name (Legal Business Name): PAIN CENTER OF MORRIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 03/31/2022
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 MORRIS AVE
ELIZABETH NJ
07208-3609
US

IV. Provider business mailing address

426 MORRIS AVE
ELIZABETH NJ
07208-3609
US

V. Phone/Fax

Practice location:
  • Phone: 908-469-4070
  • Fax: 908-469-4068
Mailing address:
  • Phone: 908-469-4070
  • Fax: 908-469-4068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberNJ4791
License Number StateNJ

VIII. Authorized Official

Name: DR. MONICA GONZALEZ
Title or Position: OWNER
Credential: DC
Phone: 908-469-4070