Provider Demographics
NPI:1780989087
Name:PAIN MANAGEMENT INSTITUTE PA
Entity type:Organization
Organization Name:PAIN MANAGEMENT INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:TENDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-738-1659
Mailing Address - Street 1:PO BOX 986520
Mailing Address - Street 2:DEPT 160
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02298-6520
Mailing Address - Country:US
Mailing Address - Phone:207-784-2554
Mailing Address - Fax:207-777-1439
Practice Address - Street 1:619 RIVER DR
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-1317
Practice Address - Country:US
Practice Address - Phone:614-553-0964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0556505Medicaid
NJ150154MFRMedicare PIN
NJ0556505Medicaid