Provider Demographics
NPI:1053500041
Name:GABRIELE JASPER MD INC
Entity Type:Organization
Organization Name:GABRIELE JASPER MD INC
Other - Org Name:CENTER FOR PAIN CONTROL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:GABRIELE
Authorized Official - Middle Name:P
Authorized Official - Last Name:JASPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-262-0700
Mailing Address - Street 1:74 BRICK BLVD BLDG 3
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-7984
Mailing Address - Country:US
Mailing Address - Phone:732-262-0700
Mailing Address - Fax:732-262-0400
Practice Address - Street 1:74 BRICK BLVD
Practice Address - Street 2:BUILDING # 3
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7984
Practice Address - Country:US
Practice Address - Phone:732-262-0700
Practice Address - Fax:732-262-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06352100261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ116949W7GMedicare PIN
NJ5993150001Medicare NSC
NJG30422Medicare UPIN