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General NPI Number Information
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NPI Number | 1396102570
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Entity Type | Organization
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Legal Business Name | ADVANCED PAIN & REHABILITATION CONSULTANTS
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 09/09/2016
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Provider Practice Location Address
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Address Line | 19 YAWPO AVE
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City | OAKLAND
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State | NJ
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Zip | 07436-2739
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Country | US
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Telephone | 973-673-0601
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Fax |
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Provider Business Mailing Address
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Address Line | 19 YAWPO AVE
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City | OAKLAND
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State | NJ
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Zip | 07436-2739
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Country | US
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Telephone | 973-673-0601
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CHINWEIKE IZEOGU
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Credential | M.D.
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Telephone | 973-673-0601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 25MA08075700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 25MA08075700
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 25MA08075700
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 25MA08075700
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License Number State | NJ
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