Healthcare Provider Details

I. General information

NPI: 1417409590
Provider Name (Legal Business Name): MOBILE PAIN SOLUTIONS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HOSPITAL DRIVE
TOMS RIVER NJ
08755-6425
US

IV. Provider business mailing address

9 HOSPITAL DRIVE
TOMS RIVER NJ
08755-6425
US

V. Phone/Fax

Practice location:
  • Phone: 732-441-7177
  • Fax: 732-441-7165
Mailing address:
  • Phone: 732-441-7177
  • Fax: 732-441-7165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number262028
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number30937
License Number StateNJ

VIII. Authorized Official

Name: MANAN PATEL
Title or Position: CO-OWNER
Credential: MD
Phone: 732-441-7177