Provider Demographics
NPI:1003218785
Name:KCS INTEGRATED PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:KCS INTEGRATED PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:JASSAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-987-8918
Mailing Address - Street 1:210 CATTAIL LN
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-1891
Mailing Address - Country:US
Mailing Address - Phone:516-987-8918
Mailing Address - Fax:
Practice Address - Street 1:210 CATTAIL LN
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-1891
Practice Address - Country:US
Practice Address - Phone:516-987-8918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09213400207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty