Provider Demographics
NPI:1891241238
Name:INTEGRITY INTERVENTIONAL PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:INTEGRITY INTERVENTIONAL PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LAWLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-758-7550
Mailing Address - Street 1:6233 JF KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-3451
Mailing Address - Country:US
Mailing Address - Phone:201-758-7550
Mailing Address - Fax:201-758-7549
Practice Address - Street 1:6233 JF KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-3451
Practice Address - Country:US
Practice Address - Phone:201-758-7550
Practice Address - Fax:201-758-7549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06538700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MB06538700OtherSTATE LICENSE