Provider Demographics
NPI:1750914776
Name:CENTER FOR REGENERATIVE THERAPY AND PAIN MANAGEMENT
Entity type:Organization
Organization Name:CENTER FOR REGENERATIVE THERAPY AND PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:KARECKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-747-7077
Mailing Address - Street 1:459 JACK MARTIN BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7724
Mailing Address - Country:US
Mailing Address - Phone:732-747-7077
Mailing Address - Fax:
Practice Address - Street 1:459 JACK MARTIN BLVD STE 4
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7724
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:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty