Healthcare Provider Details

I. General information

NPI: 1851478846
Provider Name (Legal Business Name): COMPREHENSIVE PAIN THERAPY CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 GRAND AVE FL 2
ENGLEWOOD NJ
07631-4934
US

IV. Provider business mailing address

535 GRAND AVE FL 2
ENGLEWOOD NJ
07631-4934
US

V. Phone/Fax

Practice location:
  • Phone: 201-541-1111
  • Fax: 201-541-0777
Mailing address:
  • Phone: 201-541-1111
  • Fax: 201-541-0777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number25MA05128300
License Number StateNJ

VIII. Authorized Official

Name: CHEE GAP KIM
Title or Position: PRESIDENT
Credential: MD
Phone: 201-541-1111