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General NPI Number Information
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NPI Number | 1578743431
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL PAIN CONSULTANTS OF NEW JERSEY, PA
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 5 FRANKLIN AVE SUITE 110
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City | BELLEVILLE
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State | NJ
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Zip | 07109-3532
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Country | US
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Telephone | 973-779-7354
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Fax | 973-779-7385
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Provider Business Mailing Address
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Address Line | PO BOX 4253
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City | CLIFTON
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State | NJ
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Zip | 07012-8253
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Country | US
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Telephone | 973-779-7354
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Fax | 973-779-7385
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Authorized Official
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Title or Position | CEO
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Name | DR. RAVI K VENKATARAMAN
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Credential | M.D.
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Telephone | 973-779-7354
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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 | 25MA07077100
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License Number State | NJ
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