Provider Demographics
NPI:1780303818
Name:ORTHO&PAIN CENTER OF NJ, PC
Entity type:Organization
Organization Name:ORTHO&PAIN CENTER OF NJ, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-803-1176
Mailing Address - Street 1:PO BOX 110055
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-0901
Mailing Address - Country:US
Mailing Address - Phone:201-803-1176
Mailing Address - Fax:
Practice Address - Street 1:200 FREEWAY DR E # 304
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-3809
Practice Address - Country:US
Practice Address - Phone:201-803-1176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty