Provider Demographics
NPI:1083910673
Name:NEW JERSEY ARTHRITIS AND BACK PAIN CENTER, PC.
Entity Type:Organization
Organization Name:NEW JERSEY ARTHRITIS AND BACK PAIN CENTER, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAED
Authorized Official - Middle Name:
Authorized Official - Last Name:HATTAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-224-1398
Mailing Address - Street 1:315 ELMORA AVE
Mailing Address - Street 2:SUITE # 204
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1383
Mailing Address - Country:US
Mailing Address - Phone:908-469-2820
Mailing Address - Fax:908-469-2821
Practice Address - Street 1:315 ELMORA AVE
Practice Address - Street 2:SUITE # 204
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1383
Practice Address - Country:US
Practice Address - Phone:908-469-2820
Practice Address - Fax:908-469-2821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA78007002081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI23705Medicare UPIN