Provider Demographics
NPI:1861863524
Name:BRIDGEVIEW PAIN CENTER LLC
Entity Type:Organization
Organization Name:BRIDGEVIEW PAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-585-7084
Mailing Address - Street 1:1566 LEMOINE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5635
Mailing Address - Country:US
Mailing Address - Phone:201-585-7084
Mailing Address - Fax:201-947-3860
Practice Address - Street 1:1566 LEMOINE AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5635
Practice Address - Country:US
Practice Address - Phone:201-585-7084
Practice Address - Fax:201-947-3860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain