Provider Demographics
NPI:1487091773
Name:PAIN TREATMENT CENTER
Entity type:Organization
Organization Name:PAIN TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-272-8800
Mailing Address - Street 1:226 CENTENNIAL AVE
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-3137
Mailing Address - Country:US
Mailing Address - Phone:908-272-8800
Mailing Address - Fax:908-272-8802
Practice Address - Street 1:226 CENTENNIAL AVE
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-3137
Practice Address - Country:US
Practice Address - Phone:908-272-8800
Practice Address - Fax:908-272-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty