Healthcare Provider Details

I. General information

NPI: 1992352801
Provider Name (Legal Business Name): PERFORMANCE PAIN AND SPORTS MEDICINE OF RARITAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2019
Last Update Date: 08/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 US HIGHWAY 202 STE 2A
RARITAN NJ
08869-1449
US

IV. Provider business mailing address

4126 SOUTHWEST FWY STE 1700
HOUSTON TX
77027-7317
US

V. Phone/Fax

Practice location:
  • Phone: 609-588-8600
  • Fax: 609-588-8602
Mailing address:
  • Phone: 346-217-1111
  • Fax: 346-571-2189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUZANNE M MANZI
Title or Position: OWNER / MANAGING MEMBER
Credential: MD
Phone: 848-448-7717