Provider Demographics
NPI:1235573007
Name:PAIN MANAGEMENT AND REHAB CENTER,LLC
Entity Type:Organization
Organization Name:PAIN MANAGEMENT AND REHAB CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MOHSEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MICHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-365-0008
Mailing Address - Street 1:1011 CLIFTON AVE
Mailing Address - Street 2:STE 1G
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3518
Mailing Address - Country:US
Mailing Address - Phone:973-365-0008
Mailing Address - Fax:973-365-0004
Practice Address - Street 1:1011 CLIFTON AVE
Practice Address - Street 2:STE 1G
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3518
Practice Address - Country:US
Practice Address - Phone:973-365-0008
Practice Address - Fax:973-365-0004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED INTERVENTIONAL PAIN CONSULTANTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-24
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07077100208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty