Provider Demographics
NPI:1881093219
Name:JERSEY STATE PAIN MANAGEMENT
Entity type:Organization
Organization Name:JERSEY STATE PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ-PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-758-7530
Mailing Address - Street 1:PO BOX 732
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-0732
Mailing Address - Country:US
Mailing Address - Phone:201-758-7530
Mailing Address - Fax:201-758-7529
Practice Address - Street 1:404 32ND ST APT 1
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-3966
Practice Address - Country:US
Practice Address - Phone:201-758-7530
Practice Address - Fax:201-758-7529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05052100208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty