Provider Demographics
NPI:1245522218
Name:THE OSTEOPATHIC MEDICINE, PAIN AND REHABILITATION INSTITUTE
Entity type:Organization
Organization Name:THE OSTEOPATHIC MEDICINE, PAIN AND REHABILITATION INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-869-0830
Mailing Address - Street 1:6050 BOULEVARD EAST STE LA-LB
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-3901
Mailing Address - Country:US
Mailing Address - Phone:201-869-0830
Mailing Address - Fax:201-869-9795
Practice Address - Street 1:6050 BOULEVARD EAST STE LA-LB
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-3901
Practice Address - Country:US
Practice Address - Phone:201-869-0830
Practice Address - Fax:201-869-9795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB085012002081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty