Provider Demographics
NPI:1790716702
Name:ACCUCARE MEDICAL & PAIN MANAGEMENT CTR OF NJ, PC
Entity Type:Organization
Organization Name:ACCUCARE MEDICAL & PAIN MANAGEMENT CTR OF NJ, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-967-1001
Mailing Address - Street 1:440 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILLTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08850-1725
Mailing Address - Country:US
Mailing Address - Phone:732-967-1001
Mailing Address - Fax:732-257-3287
Practice Address - Street 1:440 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILLTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08850-1725
Practice Address - Country:US
Practice Address - Phone:732-967-1001
Practice Address - Fax:732-257-3287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ084761Medicare ID - Type UnspecifiedGROUP NUMBER