Provider Demographics
NPI:1598084006
Name:EPIC PAIN MANAGEMENT & ANESTHESIA CONSULTANTS LLC
Entity Type:Organization
Organization Name:EPIC PAIN MANAGEMENT & ANESTHESIA CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSWAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-620-6415
Mailing Address - Street 1:PO BOX 1779
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-8279
Mailing Address - Country:US
Mailing Address - Phone:973-866-0336
Mailing Address - Fax:
Practice Address - Street 1:516 HAMBURG TPKE
Practice Address - Street 2:STE 2
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2062
Practice Address - Country:US
Practice Address - Phone:973-866-0336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058973A207LP2900X
PAMD434945207LP2900X
NY256512207LP2900X
NJ25MA08519500207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty