Provider Demographics
NPI:1699825927
Name:TOTAL PAIN CARE, P.A.
Entity Type:Organization
Organization Name:TOTAL PAIN CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMPINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-635-1003
Mailing Address - Street 1:PO BOX 1593
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07096-1593
Mailing Address - Country:US
Mailing Address - Phone:201-635-1003
Mailing Address - Fax:201-635-1332
Practice Address - Street 1:630 E PALISADE AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-1842
Practice Address - Country:US
Practice Address - Phone:201-503-1522
Practice Address - Fax:201-503-1514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ077996Medicare ID - Type Unspecified