Provider Demographics
NPI:1851478846
Name:COMPREHENSIVE PAIN THERAPY CENTER, PC
Entity Type:Organization
Organization Name:COMPREHENSIVE PAIN THERAPY CENTER, PC
Other - Org Name:COMPREHENSIVE PAIN THERAPY CENTER, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHEE
Authorized Official - Middle Name:GAP
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-541-1111
Mailing Address - Street 1:535 GRAND AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4934
Mailing Address - Country:US
Mailing Address - Phone:201-541-1111
Mailing Address - Fax:201-541-0777
Practice Address - Street 1:535 GRAND AVE FL 2
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4934
Practice Address - Country:US
Practice Address - Phone:201-541-1111
Practice Address - Fax:201-541-0777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05128300225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ475439Medicare ID - Type Unspecified
NJE22072Medicare UPIN