Provider Demographics
NPI:1396902946
Name:ASSOCIATED PAIN SPECIALISTS SPINE
Entity type:Organization
Organization Name:ASSOCIATED PAIN SPECIALISTS SPINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-747-7077
Mailing Address - Street 1:3822 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:PT PLEASANT
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2067
Mailing Address - Country:US
Mailing Address - Phone:732-899-0868
Mailing Address - Fax:
Practice Address - Street 1:365 BROAD ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2150
Practice Address - Country:US
Practice Address - Phone:732-747-7077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty