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General NPI Number Information
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NPI Number | 1447637632
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Entity Type | Organization
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Legal Business Name | TRISTATE PAIN CONSULTANTS, PC
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Dates
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Enumeration Date | 04/27/2015
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Last Update Date | 04/27/2015
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Provider Practice Location Address
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Address Line | 33 CLYDE RD 105
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City | SOMERSET
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State | NJ
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Zip | 08873-5032
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Country | US
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Telephone | 917-749-5701
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Fax |
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Provider Business Mailing Address
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Address Line | 33 CLYDE RD 105
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City | SOMERSET
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State | NJ
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Zip | 08873-5032
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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 | MEDICAL DIRECTOR
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Name | DR. CHINWEIKE IZEOGU
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Credential | MD
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Telephone | 917-749-5701
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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 | 25MA08075700
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License Number State | NJ
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