Provider Demographics
NPI:1346319431
Name:NORTHERN JERSEY INTERVENTIONAL PAIN SPECIALIST PC
Entity Type:Organization
Organization Name:NORTHERN JERSEY INTERVENTIONAL PAIN SPECIALIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMRISH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-974-1541
Mailing Address - Street 1:714 10TH ST
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-2921
Mailing Address - Country:US
Mailing Address - Phone:201-974-1541
Mailing Address - Fax:201-974-1581
Practice Address - Street 1:714 10TH ST
Practice Address - Street 2:SUITE 6A
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2921
Practice Address - Country:US
Practice Address - Phone:201-974-1541
Practice Address - Fax:201-974-1581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07127500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1689683542OtherNPI INDIVIDUAL NUMBER
NJG59211Medicare UPIN
NJ044005Medicare ID - Type Unspecified