Provider Demographics
NPI:1679757215
Name:PRECISION PAIN MANAGEMENT CENTER PC
Entity Type:Organization
Organization Name:PRECISION PAIN MANAGEMENT CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTAPPA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANGAVARAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-796-4007
Mailing Address - Street 1:303 MOLNAR DRIVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-3213
Mailing Address - Country:US
Mailing Address - Phone:201-796-4007
Mailing Address - Fax:201-796-4080
Practice Address - Street 1:303 MOLNAR DR
Practice Address - Street 2:1ST FLOOR
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-3213
Practice Address - Country:US
Practice Address - Phone:201-796-4002
Practice Address - Fax:201-796-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05589800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ154588Q2GMedicare PIN
NJB13425Medicare UPIN