Healthcare Provider Details

I. General information

NPI: 1871730846
Provider Name (Legal Business Name): ADVANCED PAIN MANAGEMENT AND SPINE HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 04/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 COLUMBIA TPKE UNIT 102B
FLORHAM PARK NJ
07932-2117
US

IV. Provider business mailing address

8 KRISTEN CT
SOMERSET NJ
08873-5048
US

V. Phone/Fax

Practice location:
  • Phone: 973-665-2011
  • Fax:
Mailing address:
  • Phone: 201-450-3090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number25MA08057500
License Number StateNJ

VIII. Authorized Official

Name: DR. PRASHANT PATEL
Title or Position: CEO, PRESIDENT, SOLE OWNER
Credential: MD
Phone: 201-450-3090