=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265644363
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOTOWA CENTER FOR PAIN MANAGEMENT & PHYSICAL MEDICINE,P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 290 UNION BLVD STE 1
-----------------------------------------------------
City | TOTOWA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07512-2610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-720-1700
-----------------------------------------------------
Fax | 973-720-1701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 290 UNION BLVD STE 1
-----------------------------------------------------
City | TOTOWA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07512-2610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-720-1700
-----------------------------------------------------
Fax | 973-720-1701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. CLAUDIA NIEVES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-720-1700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------