Healthcare Provider Details

I. General information

NPI: 1184681983
Provider Name (Legal Business Name): AMBULATORY PAIN MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 ROUTE 22
MOUNTAINSIDE NJ
07092-2619
US

IV. Provider business mailing address

1450 ROUTE 22
MOUNTAINSIDE NJ
07092-2619
US

V. Phone/Fax

Practice location:
  • Phone: 908-233-2020
  • Fax: 908-233-9322
Mailing address:
  • Phone: 908-233-2020
  • Fax: 908-233-9322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number22987
License Number StateNJ

VIII. Authorized Official

Name: MS. DAWN M SPENCER
Title or Position: ADMINISTRATOR
Credential: R.N.
Phone: 908-233-2010