1053500041 NPI number — GABRIELE JASPER MD INC

Table of content: (NPI 1053500041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053500041 NPI number — GABRIELE JASPER MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GABRIELE JASPER MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTER FOR PAIN CONTROL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053500041
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
74 BRICK BLVD BLDG 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08723-7984
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-262-0700
Provider Business Mailing Address Fax Number:
732-262-0400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
74 BRICK BLVD
Provider Second Line Business Practice Location Address:
BUILDING # 3
Provider Business Practice Location Address City Name:
BRICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08723-7984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-262-0700
Provider Business Practice Location Address Fax Number:
732-262-0400
Provider Enumeration Date:
10/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JASPER
Authorized Official First Name:
GABRIELE
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
732-262-0700

Provider Taxonomy Codes

  • Taxonomy code: 261QP3300X , with the licence number:  25MA06352100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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