Healthcare Provider Details

I. General information

NPI: 1720599111
Provider Name (Legal Business Name): MOBILE PAIN ENTERPRISES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HOSPITAL DR
TOMS RIVER NJ
08755-6425
US

IV. Provider business mailing address

400 ROUTE 34 SUITE A
MATAWAN NJ
07747-2155
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: DR. MANAN PATEL
Title or Position: OWNER
Credential: MD
Phone: 732-441-7177