Provider Demographics
NPI:1689130163
Name:OVERLOOK PAIN AND RECOVERY
Entity Type:Organization
Organization Name:OVERLOOK PAIN AND RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRACHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZIN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:201-645-4336
Mailing Address - Street 1:160 OVERLOOK AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2285
Mailing Address - Country:US
Mailing Address - Phone:201-645-4336
Mailing Address - Fax:201-917-1452
Practice Address - Street 1:160 OVERLOOK AVE STE 1A
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2285
Practice Address - Country:US
Practice Address - Phone:201-645-4336
Practice Address - Fax:201-917-1452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty