MEDICARE: AMBULATORY PAIN MANAGEMENT PHYSICIANS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1174526586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBULATORY PAIN MANAGEMENT PHYSICIANS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 48136
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07101-4800
Country	:	US
Telephone Number	:	201-804-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	444 MARKET ST
Second Line	:
City	:	SADDLE BROOK
State	:	NJ
Zip	:	07663-5996
Country	:	US
Telephone Number	:	201-843-9441
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JILL YOUNG
Credential	:	M.D.
Telephone Number	:	201-843-9441

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	06/13/2008

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