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General NPI Number Information
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NPI Number | 1902664394
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Entity Type | Organization
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Legal Business Name | TRISTATE PAIN ORTHOPEDICS PODIATRY AND SPINE LLC
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Dates
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Enumeration Date | 03/11/2024
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 337 BLOOMFIELD AVE
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City | NEWARK
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State | NJ
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Zip | 07107-2405
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Country | US
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Telephone | 551-580-2907
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Fax |
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Provider Business Mailing Address
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Address Line | 24 CHOPIN CT
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City | JERSEY CITY
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State | NJ
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Zip | 07302-3241
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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 | OWNER
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Name | BAKR ASIF
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Credential |
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Telephone | 551-580-2907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number |
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License Number State |
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