Provider Demographics
NPI:1932347523
Name:PAIN MANAGEMENT CENTER OF WEST ORANGE
Entity Type:Organization
Organization Name:PAIN MANAGEMENT CENTER OF WEST ORANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAIN PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:JASSIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-345-1314
Mailing Address - Street 1:6000 METRO WEST BOULEVARD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-7630
Mailing Address - Country:US
Mailing Address - Phone:407-345-1314
Mailing Address - Fax:407-345-9788
Practice Address - Street 1:6000 METRO WEST BLVD.
Practice Address - Street 2:SUITE 101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-7630
Practice Address - Country:US
Practice Address - Phone:407-345-1314
Practice Address - Fax:407-345-9788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0170989208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6259910001Medicare NSC