Provider Demographics
NPI:1588711261
Name:DOCTORS CARE PAIN RELIEF CENTER PHYSICAL THERAPY AQUATIC THERAPY & CHI
Entity type:Organization
Organization Name:DOCTORS CARE PAIN RELIEF CENTER PHYSICAL THERAPY AQUATIC THERAPY & CHI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PASQUALE
Authorized Official - Middle Name:
Authorized Official - Last Name:PUCCIARELLI
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:908-474-9444
Mailing Address - Street 1:901 N WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4039
Mailing Address - Country:US
Mailing Address - Phone:908-474-9444
Mailing Address - Fax:
Practice Address - Street 1:901 N WOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4039
Practice Address - Country:US
Practice Address - Phone:908-474-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00475900111N00000X
NJ40QA01004300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID NUMBER