Provider Demographics
NPI:1801379839
Name:NORTH JERSEY INTERVENTIONAL PAIN CENTER
Entity Type:Organization
Organization Name:NORTH JERSEY INTERVENTIONAL PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARUTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:862-222-4629
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-0429
Mailing Address - Country:US
Mailing Address - Phone:862-222-4629
Mailing Address - Fax:973-352-9519
Practice Address - Street 1:408 MAIN ST STE 101D
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1799
Practice Address - Country:US
Practice Address - Phone:862-222-4629
Practice Address - Fax:973-352-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty