Provider Demographics
NPI:1255466710
Name:HEALTHCARE PAIN & REHABILITATION
Entity Type:Organization
Organization Name:HEALTHCARE PAIN & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAIN MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-607-9000
Mailing Address - Street 1:3 HOSPITAL PLZ
Mailing Address - Street 2:SUITE 309
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3093
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:SUITE 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:2007-02-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG89817Medicare UPIN
NJG10839Medicare UPIN