Provider Demographics
NPI:1639482425
Name:COMPREHENSIVE PAIN AND REHABILITATION CENTER P.A.
Entity Type:Organization
Organization Name:COMPREHENSIVE PAIN AND REHABILITATION CENTER P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRIBBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-588-0540
Mailing Address - Street 1:234 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3507
Mailing Address - Country:US
Mailing Address - Phone:609-588-0540
Mailing Address - Fax:609-588-0197
Practice Address - Street 1:2333 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 8
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-1946
Practice Address - Country:US
Practice Address - Phone:609-588-0540
Practice Address - Fax:609-588-0197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05867000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF39980Medicare UPIN
NJ733754Medicare PIN