=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992009849
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAMILTON PAIN AND REHAB ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2011
-----------------------------------------------------
Last Update Date | 06/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2141 BRUNSWICK PIKE
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-394-5111
-----------------------------------------------------
Fax | 609-482-4972
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 55845
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08638-6845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-394-5111
-----------------------------------------------------
Fax | 609-482-4972
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. CATHY DIPASTINA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 609-392-7510
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 25MA070640
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------