Healthcare Provider Details

I. General information

NPI: 1700806551
Provider Name (Legal Business Name): CENTER FOR PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 STATE ST. SUITE 1
HACKENSACK NJ
07601-5515
US

IV. Provider business mailing address

294 STATE ST. SUITE 1
HACKENSACK NJ
07601-5515
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-7246
  • Fax: 201-488-2788
Mailing address:
  • Phone: 201-488-7246
  • Fax: 201-488-2788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) 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: MS. ANKI OLLER
Title or Position: ACCOUNT REPRESENTATIVE
Credential:
Phone: 201-525-0002