Healthcare Provider Details

I. General information

NPI: 1396902946
Provider Name (Legal Business Name): ASSOCIATED PAIN SPECIALISTS SPINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 BROAD ST
RED BANK NJ
07701-2150
US

IV. Provider business mailing address

3822 RIVER RD
PT PLEASANT NJ
08742-2067
US

V. Phone/Fax

Practice location:
  • Phone: 732-747-7077
  • Fax:
Mailing address:
  • Phone: 732-899-0868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS MANGANELLI
Title or Position: OWNER
Credential: MD
Phone: 732-747-7077