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General NPI Number Information
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NPI Number | 1013187582
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Entity Type | Organization
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Legal Business Name | GARDEN STATE PAIN AND RADIOLOGY CENTER, PC.
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 1100 ROUTE 70
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City | WHITING
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State | NJ
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Zip | 08759-1003
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Country | US
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Telephone | 732-849-0077
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Fax | 732-849-0015
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Provider Business Mailing Address
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Address Line | PO BOX 397
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City | WHITING
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State | NJ
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Zip | 08759-0397
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Country | US
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Telephone | 732-849-0077
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Fax | 732-849-0015
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Authorized Official
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Title or Position | OWNER
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Name | DR. DHARAM PAL MANN
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Credential | M.D.
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Telephone | 732-849-0077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA07706000
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License Number State | NJ
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