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General NPI Number Information
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NPI Number | 1104153907
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Entity Type | Organization
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Legal Business Name | INTEGRATED PAINCARE CENTER LLP
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Dates
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Enumeration Date | 11/16/2009
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Last Update Date | 12/07/2012
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Provider Practice Location Address
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Address Line | 252 COLUMBIA TPKE
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City | FLORHAM PARK
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State | NJ
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Zip | 07932-1248
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Country | US
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Telephone | 973-822-3338
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Fax |
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Provider Business Mailing Address
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Address Line | 252 COLUMBIA TPKE
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City | FLORHAM PARK
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State | NJ
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Zip | 07932-1248
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Country | US
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Telephone | 973-822-3338
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | TONY T JIANG
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Credential | M.D.
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Telephone | 973-822-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 25MA06699400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 25MA06497300
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License Number State | NJ
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