Healthcare Provider Details

I. General information

NPI: 1902664394
Provider Name (Legal Business Name): TRISTATE PAIN ORTHOPEDICS PODIATRY AND SPINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 08/21/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 BLOOMFIELD AVE
NEWARK NJ
07107-2405
US

IV. Provider business mailing address

24 CHOPIN CT
JERSEY CITY NJ
07302-3241
US

V. Phone/Fax

Practice location:
  • Phone: 551-580-2907
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: BAKR ASIF
Title or Position: OWNER
Credential:
Phone: 551-580-2907