=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356896245
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAIN CONTROL ASSOCIATES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2016
-----------------------------------------------------
Last Update Date | 08/07/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2271 HIGHWAY 33 STE 103
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08690-1749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-890-4080
-----------------------------------------------------
Fax | 609-890-4090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2271 HIGHWAY 33 STE 103
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08690-1749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-890-4080
-----------------------------------------------------
Fax | 609-890-4090
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARC P. PLOTNICK
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 609-744-7176
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0000X
-----------------------------------------------------
Taxonomy Name | Pain Medicine Physician
-----------------------------------------------------
License Number | 25MA05475100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number | 25MA05475100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------