Provider Demographics
NPI:1629250733
Name:PRIMA PAIN RELIEF LLC
Entity Type:Organization
Organization Name:PRIMA PAIN RELIEF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BAHER
Authorized Official - Middle Name:
Authorized Official - Last Name:YANNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-698-1000
Mailing Address - Street 1:3 CORNWALL DR
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3332
Mailing Address - Country:US
Mailing Address - Phone:732-698-1000
Mailing Address - Fax:798-698-1008
Practice Address - Street 1:3 CORNWALL DR
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3311
Practice Address - Country:US
Practice Address - Phone:732-698-1000
Practice Address - Fax:798-698-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08105700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty