Provider Demographics
NPI:1518364629
Name:OASIS ORTHOPEDIC PAIN AND WELLNESS OF UNION, LLC
Entity Type:Organization
Organization Name:OASIS ORTHOPEDIC PAIN AND WELLNESS OF UNION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-366-8800
Mailing Address - Street 1:85 HARRISTOWN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-3329
Mailing Address - Country:US
Mailing Address - Phone:844-366-8800
Mailing Address - Fax:
Practice Address - Street 1:950 WEST CHESTNUT
Practice Address - Street 2:SUITE 101
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083
Practice Address - Country:US
Practice Address - Phone:844-366-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06309600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty