Provider Demographics
NPI:1184190084
Name:NEW JERSEY INSTITUTE OF PAIN & NEUROLOGY, LLC
Entity Type:Organization
Organization Name:NEW JERSEY INSTITUTE OF PAIN & NEUROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EHTESHAM
Authorized Official - Middle Name:EDDIN
Authorized Official - Last Name:ANSARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-506-1996
Mailing Address - Street 1:329 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5804
Mailing Address - Country:US
Mailing Address - Phone:586-506-1996
Mailing Address - Fax:
Practice Address - Street 1:329 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5804
Practice Address - Country:US
Practice Address - Phone:586-506-1996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty