Healthcare Provider Details

I. General information

NPI: 1629215702
Provider Name (Legal Business Name): RIDGE PAIN MEDICINE AND ANESTHESIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 ROUTE 17 NORTH SUITE 204
PARAMUS NJ
07652
US

IV. Provider business mailing address

P.O. BOX 395
PARK RIDGE NJ
07656
US

V. Phone/Fax

Practice location:
  • Phone: 201-880-6161
  • Fax: 201-540-2552
Mailing address:
  • Phone: 201-880-6161
  • Fax: 201-540-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA08070400
License Number StateNJ

VIII. Authorized Official

Name: DR. MICHAEL BINDER
Title or Position: OWNER/CEO
Credential: M.D.
Phone: 201-880-6161