Provider Demographics
NPI:1376735811
Name:CENTER FOR PAIN CONTROL NEW BRUNSWICK, LLC
Entity Type:Organization
Organization Name:CENTER FOR PAIN CONTROL NEW BRUNSWICK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:GABRIELE
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:JASPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-262-0700
Mailing Address - Street 1:440 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILLTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08850-1725
Mailing Address - Country:US
Mailing Address - Phone:732-967-0050
Mailing Address - Fax:
Practice Address - Street 1:440 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILLTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08850-1725
Practice Address - Country:US
Practice Address - Phone:732-967-0050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06352100261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ114545Medicare PIN