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General NPI Number Information
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NPI Number | 1417898727
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Entity Type | Organization
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Legal Business Name | ORIGIN MEDICAL GROUP LLC
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Dates
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Enumeration Date | 04/02/2026
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Last Update Date | 04/02/2026
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Provider Practice Location Address
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Address Line | 401 HAMBURG TPKE STE 310
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City | WAYNE
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State | NJ
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Zip | 07470-2139
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Country | US
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Telephone | 973-310-5497
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Fax | 862-298-0729
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Provider Business Mailing Address
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Address Line | 189 BERDAN AVE UNIT 171
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City | WAYNE
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State | NJ
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Zip | 07470-3233
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Country | US
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Telephone | 973-310-5497
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Fax | 862-298-0729
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Authorized Official
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Title or Position | OWNER
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Name | AMIR ISSA
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Credential |
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Telephone | 973-310-5497
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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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