Provider Demographics
NPI:1215631452
Name:EDISON PAIN & REHAB CENTER LLC
Entity type:Organization
Organization Name:EDISON PAIN & REHAB CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ORECCHIO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:201-787-9293
Mailing Address - Street 1:2249 WOODBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-5554
Mailing Address - Country:US
Mailing Address - Phone:732-317-4141
Mailing Address - Fax:732-317-4142
Practice Address - Street 1:2249 WOODBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-5554
Practice Address - Country:US
Practice Address - Phone:732-317-4141
Practice Address - Fax:732-317-4142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1437376613OtherCHIROPRACTOR