Provider Demographics
NPI:1437579505
Name:PRIME PAIN CLINIC P.C.
Entity Type:Organization
Organization Name:PRIME PAIN CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TAE SIK
Authorized Official - Middle Name:
Authorized Official - Last Name:RA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:201-313-1122
Mailing Address - Street 1:118 BROAD AVE SUITE N10
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650
Mailing Address - Country:US
Mailing Address - Phone:201-313-1122
Mailing Address - Fax:201-941-1157
Practice Address - Street 1:118 BROAD AVE
Practice Address - Street 2:STE N10
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650
Practice Address - Country:US
Practice Address - Phone:201-313-1122
Practice Address - Fax:201-941-1157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty