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General NPI Number Information
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NPI Number | 1417193285
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Entity Type | Organization
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Legal Business Name | PAIN AND REHABILITATION MEDICINE LLC
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Dates
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Enumeration Date | 12/30/2008
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Last Update Date | 12/10/2010
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Provider Practice Location Address
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Address Line | 223 N VAN DIEN AVE
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-2726
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Country | US
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Telephone | 201-690-6122
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 422
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City | HILLSDALE
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State | NJ
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Zip | 07642-0422
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Country | US
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Telephone | 201-690-6122
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BEENA S BALAKRISHNAN
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Credential | MD
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Telephone | 201-690-6122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MA07973200
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License Number State | NJ
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