Healthcare Provider Details

I. General information

NPI: 1699825927
Provider Name (Legal Business Name): TOTAL PAIN CARE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 E PALISADE AVE
ENGLEWOOD CLIFFS NJ
07632-1842
US

IV. Provider business mailing address

PO BOX 1593
SECAUCUS NJ
07096-1593
US

V. Phone/Fax

Practice location:
  • Phone: 201-503-1522
  • Fax: 201-503-1514
Mailing address:
  • Phone: 201-635-1003
  • Fax: 201-635-1332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: BRIDGET CHAMPINO
Title or Position: OFFICE MANAGER
Credential:
Phone: 201-635-1003