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General NPI Number Information
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NPI Number | 1174707954
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Entity Type | Organization
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Legal Business Name | UNIVERSITY PAIN MEDICINE CENTER, LLC
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | 59 VERONICA AVE
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City | SOMERSET
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State | NJ
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Zip | 08873-3448
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Country | US
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Telephone | 732-873-6868
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Fax | 732-873-6869
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Provider Business Mailing Address
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Address Line | 59 VERONICA AVE
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City | SOMERSET
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State | NJ
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Zip | 08873-3448
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Country | US
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Telephone | 732-873-6868
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Fax | 732-873-6869
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DIDIER DEMESMIN
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Credential | MD
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Telephone | 732-873-6868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 25MA07892100
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License Number State | NJ
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