| NPI | 1063746527 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATIE BOLEN Manager 973-794-4704 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 235083) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: NJ 25MA07658100) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: NY 235083) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA07658100) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: NJ 25MA07658100) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: NY 235083) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NJ 25MA07658100) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 235083) | |
| Enumeration Date | 2009-09-30 |
| Last Update Date | 2020-02-13 |