Provider Demographics
NPI:1174260731
Name:ADVANCED ORTHO & PAIN CENTER INC
Entity Type:Organization
Organization Name:ADVANCED ORTHO & PAIN CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MERWIN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC
Authorized Official - Phone:914-310-3101
Mailing Address - Street 1:550 NEWARK AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1356
Mailing Address - Country:US
Mailing Address - Phone:201-624-2111
Mailing Address - Fax:201-795-0148
Practice Address - Street 1:550 NEWARK AVE STE 304
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1356
Practice Address - Country:US
Practice Address - Phone:201-624-2111
Practice Address - Fax:201-795-0148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA07291400OtherSTATE LICENSE