Healthcare Provider Details

I. General information

NPI: 1659640589
Provider Name (Legal Business Name): REGIONAL PAIN CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 S NEW RD
PLEASANTVILLE NJ
08232-3730
US

IV. Provider business mailing address

1004 NEW ROAD
PLEASANTVILLE NJ
08232-3730
US

V. Phone/Fax

Practice location:
  • Phone: 609-652-4141
  • Fax: 609-652-9939
Mailing address:
  • Phone: 609-652-4141
  • Fax: 609-652-9939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA06434200
License Number StateNJ

VIII. Authorized Official

Name: DR. ABDUL QADIR
Title or Position: MD
Credential: MD
Phone: 609-652-4141