Provider Demographics
NPI:1841596533
Name:ADVANCED PAIN THERAPY LLC
Entity type:Organization
Organization Name:ADVANCED PAIN THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCELLO
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMMARONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-294-6228
Mailing Address - Street 1:1130 ROUTE 46 WEST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054
Mailing Address - Country:US
Mailing Address - Phone:973-294-6228
Mailing Address - Fax:973-917-3174
Practice Address - Street 1:1130 ROUTE 46 WEST
Practice Address - Street 2:SUITE 1
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054
Practice Address - Country:US
Practice Address - Phone:973-294-6228
Practice Address - Fax:973-917-3174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05745200207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7918909Medicaid
NJ010547Medicare PIN