1053749416 NPI number — PAIN AND NEUROPATHY CENTER OF PA PC

Table of content: (NPI 1053749416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053749416 NPI number — PAIN AND NEUROPATHY CENTER OF PA PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAIN AND NEUROPATHY CENTER OF PA PC
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:
Provider Other Organization Name Type Code:
6
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:
1053749416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
181 JERSEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT JERVIS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12771-2609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-917-3800
Provider Business Mailing Address Fax Number:
732-228-7427

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
181 JERSEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT JERVIS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12771-2609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-917-3800
Provider Business Practice Location Address Fax Number:
732-228-7427
Provider Enumeration Date:
10/23/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KUMAR
Authorized Official First Name:
AJAY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
973-917-3800

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  MD423585 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X , with the licence number: 25MA07877200 , 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)





Copyright © 2007-2025 www.npivalidator.com