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General NPI Number Information
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NPI Number | 1881145092
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Entity Type | Organization
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Legal Business Name | MERIDIAN PAIN MANAGEMENT & WELLNESS LLC
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Dates
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Enumeration Date | 10/23/2016
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Last Update Date | 10/23/2016
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Provider Practice Location Address
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Address Line | 1 TAYLOR DR
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City | CLOSTER
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State | NJ
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Zip | 07624-2806
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Country | US
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Telephone | 908-265-5358
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Fax |
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Provider Business Mailing Address
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Address Line | 1 TAYLOR DR
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City | CLOSTER
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State | NJ
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Zip | 07624-2806
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Country | US
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Telephone | 908-265-5358
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. OFER M WELLISCH
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Credential | M.D. M.P.H.
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Telephone | 908-265-5358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 25MA09636000
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License Number State | NJ
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