Healthcare Provider Details

I. General information

NPI: 1174526586
Provider Name (Legal Business Name): AMBULATORY PAIN MANAGEMENT PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 MARKET ST
SADDLE BROOK NJ
07663-5996
US

IV. Provider business mailing address

PO BOX 48136
NEWARK NJ
07101-4800
US

V. Phone/Fax

Practice location:
  • Phone: 201-843-9441
  • Fax:
Mailing address:
  • Phone: 201-804-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JILL YOUNG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-843-9441