Provider Demographics
NPI:1528075652
Name:PARK AVE PAIN TREATMENT CENTER PC
Entity type:Organization
Organization Name:PARK AVE PAIN TREATMENT CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:PRAMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BYAHATTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-756-2227
Mailing Address - Street 1:1907 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5530
Mailing Address - Country:US
Mailing Address - Phone:908-756-2227
Mailing Address - Fax:908-668-0455
Practice Address - Street 1:1907 PARK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5530
Practice Address - Country:US
Practice Address - Phone:908-756-2227
Practice Address - Fax:908-668-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ826173Medicare ID - Type Unspecified