Provider Demographics
NPI:1679861322
Name:SENSORY DIAGNOSTICS AND PAIN MANAGEMENT ASSOCIATES
Entity Type:Organization
Organization Name:SENSORY DIAGNOSTICS AND PAIN MANAGEMENT ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROETMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-497-6612
Mailing Address - Street 1:183 OLD TAPPAN RD STE 2
Mailing Address - Street 2:
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-7088
Mailing Address - Country:US
Mailing Address - Phone:201-497-6612
Mailing Address - Fax:
Practice Address - Street 1:183 OLD TAPPAN RD STE 2
Practice Address - Street 2:
Practice Address - City:OLD TAPPAN
Practice Address - State:NJ
Practice Address - Zip Code:07675-7088
Practice Address - Country:US
Practice Address - Phone:201-497-6612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0400423183261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center