Healthcare Provider Details

I. General information

NPI: 1558501601
Provider Name (Legal Business Name): NEW JERSEY PAIN CARE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 STATE RT 23 STE 15B
RIVERDALE NJ
07457-1603
US

IV. Provider business mailing address

44 STATE RT 23 STE 15B
RIVERDALE NJ
07457-1603
US

V. Phone/Fax

Practice location:
  • Phone: 973-400-1716
  • Fax: 973-400-1631
Mailing address:
  • Phone: 973-400-1716
  • Fax: 973-400-1631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LH0002X
TaxonomyHospice and Palliative Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHY IODICE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 973-400-1716