Provider Demographics
NPI:1346403631
Name:ADVANCED PAIN MANAGEMENT OF NORTH JERSEY LLC
Entity type:Organization
Organization Name:ADVANCED PAIN MANAGEMENT OF NORTH JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NESTAMPOWER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-644-7700
Mailing Address - Street 1:55 WANAQUE AVE STE 134
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-2085
Mailing Address - Country:US
Mailing Address - Phone:201-644-7700
Mailing Address - Fax:201-644-7195
Practice Address - Street 1:55 WANAQUE AVE
Practice Address - Street 2:SUITE 134
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-2085
Practice Address - Country:US
Practice Address - Phone:201-644-7700
Practice Address - Fax:201-644-7195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty