Provider Demographics
NPI:1073815494
Name:TRISTATE REHAB AND PAIN MANAGEMENT PC
Entity Type:Organization
Organization Name:TRISTATE REHAB AND PAIN MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-970-8655
Mailing Address - Street 1:680 BROADWAY STE 2A
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1422
Mailing Address - Country:US
Mailing Address - Phone:973-225-0723
Mailing Address - Fax:212-671-1414
Practice Address - Street 1:680 BROADWAY SUITE 2A
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-0000
Practice Address - Country:US
Practice Address - Phone:973-225-0723
Practice Address - Fax:212-671-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty