Healthcare Provider Details

I. General information

NPI: 1801352786
Provider Name (Legal Business Name): EDISON INJURY AND PAIN CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 LAKE ST
RAMSEY NJ
07446-2089
US

IV. Provider business mailing address

1090 KING GEORGES POST RD STE 501
EDISON NJ
08837-3722
US

V. Phone/Fax

Practice location:
  • Phone: 201-327-1990
  • Fax: 201-327-1921
Mailing address:
  • Phone: 732-661-1121
  • Fax: 732-661-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MISS MICHELLE K WECKESSER
Title or Position: OFFICE MANAGER
Credential:
Phone: 732-661-1121