1295131175 NPI number — ABSOLUTE INTERVENTIONAL PAIN MEDICINE AND REHAB PC

Table of content: DR. STACEY BARRON MILLER MD (NPI 1992189815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295131175 NPI number — ABSOLUTE INTERVENTIONAL PAIN MEDICINE AND REHAB PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABSOLUTE INTERVENTIONAL PAIN MEDICINE AND REHAB 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:
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:
1295131175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1317 BOUND BROOK ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLESEX
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-748-9944
Provider Business Mailing Address Fax Number:
732-748-0800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1317 BOUND BROOK ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLESEX
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-748-9944
Provider Business Practice Location Address Fax Number:
732-748-0800
Provider Enumeration Date:
11/05/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RAHAT
Authorized Official First Name:
SAM
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
347-683-3008

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QA0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NX0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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