Provider Demographics
NPI:1740548478
Name:ADVANCED PAIN SOLUTIONS PC
Entity type:Organization
Organization Name:ADVANCED PAIN SOLUTIONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-226-6603
Mailing Address - Street 1:670 N BEERS ST
Mailing Address - Street 2:BLDG 2, SUIE 1
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1516
Mailing Address - Country:US
Mailing Address - Phone:732-226-6603
Mailing Address - Fax:888-500-0606
Practice Address - Street 1:670 N BEERS ST
Practice Address - Street 2:BLDG 2, SUIE 1
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1516
Practice Address - Country:US
Practice Address - Phone:732-226-6603
Practice Address - Fax:888-500-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08003800208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I15183Medicare UPIN