Provider Demographics
NPI:1710352000
Name:INJURY & PAIN CENTER OF EAST ORANGE,LLC
Entity Type:Organization
Organization Name:INJURY & PAIN CENTER OF EAST ORANGE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RENATO
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPPELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-672-7246
Mailing Address - Street 1:633 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1402
Mailing Address - Country:US
Mailing Address - Phone:973-672-7246
Mailing Address - Fax:
Practice Address - Street 1:633 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1402
Practice Address - Country:US
Practice Address - Phone:973-672-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00643000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty