Provider Demographics
NPI:1497108799
Name:CENTRAL JERSEY ANESTHESIA AND PAIN MANAGEMENT PA
Entity Type:Organization
Organization Name:CENTRAL JERSEY ANESTHESIA AND PAIN MANAGEMENT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAJAKTA
Authorized Official - Middle Name:V
Authorized Official - Last Name:AVHAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-565-3777
Mailing Address - Street 1:2090 ROUTE 27
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1142
Mailing Address - Country:US
Mailing Address - Phone:732-565-3777
Mailing Address - Fax:609-228-7269
Practice Address - Street 1:2090 ROUTE 27
Practice Address - Street 2:SUITE 103
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1142
Practice Address - Country:US
Practice Address - Phone:732-565-3777
Practice Address - Fax:609-228-7269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09001500207LP2900X
NY257357207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty