Provider Demographics
NPI:1568591188
Name:COMPREHENSIVE PAIN MANAGEMENT OF CENTRAL NJ LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE PAIN MANAGEMENT OF CENTRAL NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:APARNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:908-904-1900
Mailing Address - Street 1:726 ROUTE 202 SOUTH
Mailing Address - Street 2:SUITE 320 332
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2551
Mailing Address - Country:US
Mailing Address - Phone:908-904-1900
Mailing Address - Fax:908-904-1908
Practice Address - Street 1:501 OMNI DRIVE
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4528
Practice Address - Country:US
Practice Address - Phone:908-904-1900
Practice Address - Fax:908-904-1908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05994100208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6497608Medicaid
NJ095458Medicare PIN
G04491Medicare UPIN