Provider Demographics
NPI:1972552115
Name:ENGLEWOOD PAIN CENTER, P.A.
Entity Type:Organization
Organization Name:ENGLEWOOD PAIN CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARYEH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-871-6073
Mailing Address - Street 1:375 ENGLE ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1823
Mailing Address - Country:US
Mailing Address - Phone:201-871-6073
Mailing Address - Fax:201-871-0619
Practice Address - Street 1:350 ENGLE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1808
Practice Address - Country:US
Practice Address - Phone:201-871-0673
Practice Address - Fax:201-871-0619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDE0144OtherRAILROAD MEDICARE
NJ8432601Medicaid
NJ045505Medicare ID - Type UnspecifiedEMPIRE MEDICARE