Provider Demographics
NPI:1033497714
Name:NJ PAIN & SPINE PC
Entity Type:Organization
Organization Name:NJ PAIN & SPINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-593-5484
Mailing Address - Street 1:1037 US HIGHWAY 46 STE 103A
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2461
Mailing Address - Country:US
Mailing Address - Phone:888-233-3415
Mailing Address - Fax:888-250-6364
Practice Address - Street 1:1037 US HIGHWAY 46 STE 103A
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2461
Practice Address - Country:US
Practice Address - Phone:888-233-3415
Practice Address - Fax:888-250-6364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08796800207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0929361Medicaid