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General NPI Number Information
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NPI Number | 1346618808
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Entity Type | Organization
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Legal Business Name | PAIN RELIEF CENTRAL NEW JERSEY LLC
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Dates
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Enumeration Date | 09/14/2015
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Last Update Date | 09/14/2015
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Provider Practice Location Address
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Address Line | 1131 BROAD ST 201
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City | SHREWSBURY
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State | NJ
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Zip | 07702-4329
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Country | US
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Telephone | 908-692-9833
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 62 201
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City | LONG BRANCH
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State | NJ
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Zip | 07740-0062
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE KEEGAN
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Credential | ANP
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Telephone | 908-692-9833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NJ00253100
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License Number State | NJ
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