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General NPI Number Information
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NPI Number | 1295040749
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Entity Type | Organization
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Legal Business Name | MKG PAIN ASSOCIATES, LLC
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Dates
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Enumeration Date | 08/09/2010
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Last Update Date | 08/09/2010
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Provider Practice Location Address
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Address Line | 401 BETHEL RD
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City | SOMERS POINT
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State | NJ
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Zip | 08244-2108
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Country | US
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Telephone | 609-601-7601
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 646
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City | LUMBERTON
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State | NJ
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Zip | 08048-0646
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Country | US
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Telephone | 201-804-2800
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Fax | 201-804-8883
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JOSEPH B NYZIO
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Credential | DO
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Telephone | 609-601-7601
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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 |
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License Number State |
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