Provider Demographics
NPI:1528119278
Name:CENTRAL PAIN MGMT OF NJ
Entity type:Organization
Organization Name:CENTRAL PAIN MGMT OF NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MISS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALLONIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-332-9280
Mailing Address - Street 1:200 STATE ROUTE 34 N
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1234
Mailing Address - Country:US
Mailing Address - Phone:732-332-9280
Mailing Address - Fax:732-332-0444
Practice Address - Street 1:200 STATE ROUTE 34 N
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-1234
Practice Address - Country:US
Practice Address - Phone:732-332-9280
Practice Address - Fax:732-332-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB70770208100000X
NJ40QA01163000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty