Provider Demographics
NPI:1982902268
Name:TWIN RIVERS PAIN MANAGEMENT PC
Entity Type:Organization
Organization Name:TWIN RIVERS PAIN MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KANDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-777-5444
Mailing Address - Street 1:755 MEMORIAL PKWY
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-2748
Mailing Address - Country:US
Mailing Address - Phone:908-454-5338
Mailing Address - Fax:908-454-0338
Practice Address - Street 1:755 MEMORIAL PKWY
Practice Address - Street 2:SUITE 202A
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2748
Practice Address - Country:US
Practice Address - Phone:908-454-5338
Practice Address - Fax:908-454-0338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08387400207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6633650001Medicare NSC