Provider Demographics
NPI:1427414010
Name:JERSEY PREMIER PAIN
Entity Type:Organization
Organization Name:JERSEY PREMIER PAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MINGOIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-436-0911
Mailing Address - Street 1:550 NEWARK AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1326
Mailing Address - Country:US
Mailing Address - Phone:201-386-8800
Mailing Address - Fax:201-386-8801
Practice Address - Street 1:550 NEWARK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1326
Practice Address - Country:US
Practice Address - Phone:201-386-8800
Practice Address - Fax:201-386-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00645300111N00000X
NJ38MC00473900111N00000X
363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty