Provider Demographics
NPI:1588851927
Name:CENTER FOR PAIN MANAGEMENT AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:CENTER FOR PAIN MANAGEMENT AND REHABILITATION, LLC
Other - Org Name:CENTER FOR PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QING
Authorized Official - Middle Name:
Authorized Official - Last Name:TAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:908-231-1131
Mailing Address - Street 1:635 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3341
Mailing Address - Country:US
Mailing Address - Phone:908-231-1131
Mailing Address - Fax:908-231-1132
Practice Address - Street 1:635 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3341
Practice Address - Country:US
Practice Address - Phone:908-231-1131
Practice Address - Fax:908-231-1132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA073550261QP3300X
NJMA 073550261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJY38410Medicare UPIN
NJ092732Medicare PIN