Provider Demographics
NPI:1023196094
Name:GARDEN STATE SPINE AND PAIN INSTITUTE LLC
Entity Type:Organization
Organization Name:GARDEN STATE SPINE AND PAIN INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-935-1000
Mailing Address - Street 1:7 MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2242
Mailing Address - Country:US
Mailing Address - Phone:732-935-1000
Mailing Address - Fax:732-935-9100
Practice Address - Street 1:7 MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2242
Practice Address - Country:US
Practice Address - Phone:732-935-1000
Practice Address - Fax:732-935-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00542300111N00000X
NJ38MC00475800111N00000X
NM25MZ00052600171100000X
NJ25MZ00035200171100000X
NJ25MZ00038300171100000X
NJ25MA07807000208100000X
NJ25MB07638100208100000X
NJ25MA07847300208VP0014X
NJ40QA01192300225100000X
NJ40QA01205100225100000X
NJ40QA00722100225100000X
NJ40QA01101200225100000X
NJ40QA00941400225100000X
NJ40QA01152600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ080668Medicare PIN
NJ6045210001Medicare NSC