Provider Demographics
NPI:1649706896
Name:PRESTIGE PAIN CENTERS PC
Entity type:Organization
Organization Name:PRESTIGE PAIN CENTERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GURBIR
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-441-7177
Mailing Address - Street 1:400 ROUTE 34
Mailing Address - Street 2:SUITE A
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2155
Mailing Address - Country:US
Mailing Address - Phone:732-441-7177
Mailing Address - Fax:732-441-7165
Practice Address - Street 1:125 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008-2635
Practice Address - Country:US
Practice Address - Phone:732-441-7177
Practice Address - Fax:732-441-7165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10000100208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty