Provider Demographics
NPI:1255314464
Name:HEALTHCARE PAIN & REHABILITATION INC
Entity Type:Organization
Organization Name:HEALTHCARE PAIN & REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:P
Authorized Official - Last Name:DEL VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-607-9000
Mailing Address - Street 1:PO BOX 315
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-0315
Mailing Address - Country:US
Mailing Address - Phone:732-607-9000
Mailing Address - Fax:732-607-7706
Practice Address - Street 1:3 HOSPITAL PLZ
Practice Address - Street 2:STE 309
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3093
Practice Address - Country:US
Practice Address - Phone:732-607-9000
Practice Address - Fax:732-607-7706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06091700261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8048509Medicaid
NJ8048509Medicaid