Provider Demographics
NPI:1184681983
Name:AMBULATORY PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:AMBULATORY PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:908-233-2010
Mailing Address - Street 1:1450 ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2619
Mailing Address - Country:US
Mailing Address - Phone:908-233-2020
Mailing Address - Fax:908-233-9322
Practice Address - Street 1:1450 ROUTE 22
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2619
Practice Address - Country:US
Practice Address - Phone:908-233-2020
Practice Address - Fax:908-233-9322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22987261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ088175Medicare ID - Type Unspecified