Provider Demographics
NPI:1972978765
Name:RIVERSIDE PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:RIVERSIDE PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EN-CHIA JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-509-8179
Mailing Address - Street 1:1025 MAXWELL LN APT 515
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6825
Mailing Address - Country:US
Mailing Address - Phone:917-509-8179
Mailing Address - Fax:
Practice Address - Street 1:1025 MAXWELL LN APT 515
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6825
Practice Address - Country:US
Practice Address - Phone:917-509-8179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-06
Last Update Date:2015-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08583600261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain