Provider Demographics
NPI:1578944278
Name:PAIN RELIEF CENTER OF CENTRAL NEW JERSEY, LLC
Entity Type:Organization
Organization Name:PAIN RELIEF CENTER OF CENTRAL NEW JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APN
Authorized Official - Phone:908-692-9833
Mailing Address - Street 1:855 WOODGATE AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-4871
Mailing Address - Country:US
Mailing Address - Phone:908-692-9833
Mailing Address - Fax:
Practice Address - Street 1:855 WOODGATE AVE
Practice Address - Street 2:APT 2
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-4871
Practice Address - Country:US
Practice Address - Phone:908-692-9833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain