=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619132271
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR ADVANCED PAIN MANAGEMENT AND CLINICAL ORTHOPAEDICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2008
-----------------------------------------------------
Last Update Date | 12/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 LUCERNE DR
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-2135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-722-7593
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 LUCERNE DR
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-2135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-722-7593
-----------------------------------------------------
Fax | 732-722-7593
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DOCTOR
-----------------------------------------------------
Name | DR. MOISES KAWEBLUM
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 732-948-5241
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0000X
-----------------------------------------------------
Taxonomy Name | Pain Medicine Physician
-----------------------------------------------------
License Number | 25MA07181100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------