Healthcare Provider Details

I. General information

NPI: 1881093219
Provider Name (Legal Business Name): JERSEY STATE PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 32ND ST APT 1
UNION CITY NJ
07087-3966
US

IV. Provider business mailing address

PO BOX 732
UNION CITY NJ
07087-0732
US

V. Phone/Fax

Practice location:
  • Phone: 201-758-7530
  • Fax: 201-758-7529
Mailing address:
  • Phone: 201-758-7530
  • Fax: 201-758-7529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number25MA05052100
License Number StateNJ

VIII. Authorized Official

Name: DR. LUIS RAMIREZ-PACHECO
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 201-758-7530