Healthcare Provider Details

I. General information

NPI: 1366448979
Provider Name (Legal Business Name): NEW JERSEY PAIN CONSULTANTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MADISON AVE SUITE 301
MORRISTOWN NJ
07960-6967
US

IV. Provider business mailing address

PO BOX 24004
NEWARK NJ
07101-0406
US

V. Phone/Fax

Practice location:
  • Phone: 973-998-9200
  • Fax:
Mailing address:
  • Phone: 201-804-2800
  • Fax: 201-804-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNJ

VIII. Authorized Official

Name: MICHAEL E RUDMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 973-971-6824