Healthcare Provider Details

I. General information

NPI: 1295040749
Provider Name (Legal Business Name): MKG PAIN ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BETHEL RD
SOMERS POINT NJ
08244-2108
US

IV. Provider business mailing address

PO BOX 646
LUMBERTON NJ
08048-0646
US

V. Phone/Fax

Practice location:
  • Phone: 609-601-7601
  • Fax:
Mailing address:
  • Phone: 201-804-2800
  • Fax: 201-804-8883

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: JOSEPH B NYZIO
Title or Position: AUTHORIZED OFFICIAL
Credential: DO
Phone: 609-601-7601