Provider Demographics
NPI:1801040001
Name:MONTCLAIR PAIN MANAGEMENT
Entity Type:Organization
Organization Name:MONTCLAIR PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGNORELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-447-7440
Mailing Address - Street 1:PO BOX 43233
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-0233
Mailing Address - Country:US
Mailing Address - Phone:973-447-7440
Mailing Address - Fax:
Practice Address - Street 1:51 UPPER MONTCLAIR PLZ
Practice Address - Street 2:SUITE 24
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1343
Practice Address - Country:US
Practice Address - Phone:973-447-7440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00478600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty