Provider Demographics
NPI:1134220890
Name:PAIN CENTERS OF AMERICA, PA
Entity type:Organization
Organization Name:PAIN CENTERS OF AMERICA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAO
Authorized Official - Middle Name:
Authorized Official - Last Name:GEDALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-779-7354
Mailing Address - Street 1:1060 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3638
Mailing Address - Country:US
Mailing Address - Phone:973-779-7354
Mailing Address - Fax:973-779-7385
Practice Address - Street 1:1060 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3638
Practice Address - Country:US
Practice Address - Phone:973-779-7354
Practice Address - Fax:973-779-7354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0064181Medicaid
NJ0064181Medicaid
NJ086832Medicare ID - Type Unspecified