Healthcare Provider Details

I. General information

NPI: 1508844820
Provider Name (Legal Business Name): METROPAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SALEM RD SUITE B
WILLINGBORO NJ
08046-2852
US

IV. Provider business mailing address

10 COMMERCE DR
NEW ROCHELLE NY
10801-5214
US

V. Phone/Fax

Practice location:
  • Phone: 877-476-6642
  • Fax:
Mailing address:
  • Phone: 914-637-3510
  • Fax: 914-819-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARC E. KOCH
Title or Position: PRESIDENT & CEO
Credential: M.D.
Phone: 914-637-3511