Provider Demographics
NPI:1962410621
Name:COMPREHENSIVE PAIN MANAGEMENT, LLC
Entity type:Organization
Organization Name:COMPREHENSIVE PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALPHONSE
Authorized Official - Last Name:LEPIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-223-2873
Mailing Address - Street 1:2420 HWY 34
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736
Mailing Address - Country:US
Mailing Address - Phone:732-223-2873
Mailing Address - Fax:732-223-5726
Practice Address - Street 1:2420 HWY 34
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736
Practice Address - Country:US
Practice Address - Phone:732-223-2873
Practice Address - Fax:732-223-5726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07363300208100000X
208VP0000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8830908Medicaid
2253382000OtherAMERIHEALTH
2K3128OtherHEALTHNET
NJ043675925OtherBLUE CROSS BLUE SHIELD
192671OtherAMERIGROUP
73Z641OtherWELLCHOICE
4358367OtherCIGNA
3120203OtherAETNA
P2728923OtherOXFORD
73Z641OtherWELLCHOICE
NJ8830908Medicaid
NJ096576Medicare PIN
NJ043675925OtherBLUE CROSS BLUE SHIELD