Provider Demographics
NPI:1306189691
Name:ABACI AND MASSEY PAIN MANAGEMENT CENTER, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ABACI AND MASSEY PAIN MANAGEMENT CENTER, A MEDICAL CORPORATION
Other - Org Name:BAY AREA PAIN & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PELTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-461-7246
Mailing Address - Street 1:1050 NORTHGATE DR
Mailing Address - Street 2:SUITE 460
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2526
Mailing Address - Country:US
Mailing Address - Phone:415-461-7246
Mailing Address - Fax:415-461-2476
Practice Address - Street 1:1050 NORTHGATE DR
Practice Address - Street 2:SUITE 460
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2526
Practice Address - Country:US
Practice Address - Phone:415-461-7246
Practice Address - Fax:415-461-2476
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPWC MEDICAL GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-04
Last Update Date:2014-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ213054ZMedicare UPIN