Provider Demographics
NPI:1437256658
Name:THE BACK PAIN CENTER, LLC
Entity Type:Organization
Organization Name:THE BACK PAIN CENTER, LLC
Other - Org Name:ADVANCED MEDICAL, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:GIGANTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-445-1079
Mailing Address - Street 1:83 FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1820
Mailing Address - Country:US
Mailing Address - Phone:201-445-1079
Mailing Address - Fax:201-445-1315
Practice Address - Street 1:83 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1820
Practice Address - Country:US
Practice Address - Phone:201-445-1079
Practice Address - Fax:201-445-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6422110001Medicare NSC
NJ029455NFOMedicare ID - Type Unspecified