Healthcare Provider Details

I. General information

NPI: 1215230321
Provider Name (Legal Business Name): PAIN SPECIALISTS OF NEW YORK AND NEW JERSEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 SOUTH DEAN STREET
ENGLEWOOD NJ
07631
US

IV. Provider business mailing address

54 SOUTH DEAN STREET
ENGLEWOOD NJ
07631
US

V. Phone/Fax

Practice location:
  • Phone: 201-871-4000
  • Fax: 201-568-6851
Mailing address:
  • Phone: 201-871-4000
  • Fax: 201-568-6851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANSON M MOISE
Title or Position: MEMBER
Credential: MD
Phone: 12018714000