Healthcare Provider Details

I. General information

NPI: 1689130163
Provider Name (Legal Business Name): OVERLOOK PAIN AND RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 OVERLOOK AVE STE 1A
HACKENSACK NJ
07601-2285
US

IV. Provider business mailing address

160 OVERLOOK AVE STE 1A
HACKENSACK NJ
07601-2285
US

V. Phone/Fax

Practice location:
  • Phone: 201-645-4336
  • Fax: 201-917-1452
Mailing address:
  • Phone: 201-645-4336
  • Fax: 201-917-1452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. BRACHA MAZIN
Title or Position: PHYSICIAN ASSISTANT
Credential: PA-C
Phone: 201-645-4336