Provider Demographics
NPI:1992352801
Name:PERFORMANCE PAIN AND SPORTS MEDICINE OF RARITAN LLC
Entity type:Organization
Organization Name:PERFORMANCE PAIN AND SPORTS MEDICINE OF RARITAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:848-448-7717
Mailing Address - Street 1:4126 SOUTHWEST FWY STE 1700
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7317
Mailing Address - Country:US
Mailing Address - Phone:346-217-1111
Mailing Address - Fax:346-571-2189
Practice Address - Street 1:903 US HIGHWAY 202 STE 2A
Practice Address - Street 2:
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-1449
Practice Address - Country:US
Practice Address - Phone:609-588-8600
Practice Address - Fax:609-588-8602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-25
Last Update Date:2019-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty