Provider Demographics
NPI:1316133481
Name:PAINCARE & REHAB CENTER
Entity type:Organization
Organization Name:PAINCARE & REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIMI
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-822-3338
Mailing Address - Street 1:15 JAMES ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1346
Mailing Address - Country:US
Mailing Address - Phone:973-822-3338
Mailing Address - Fax:973-822-8098
Practice Address - Street 1:15 JAMES ST
Practice Address - Street 2:SUITE 2
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1346
Practice Address - Country:US
Practice Address - Phone:973-822-3338
Practice Address - Fax:973-822-8098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND7781300Medicaid
NJDC3165OtherRAILROAD MEDICARE
NJG43185Medicare UPIN
ND7781300Medicaid