Provider Demographics
NPI:1487878914
Name:ESSEX PAIN MANAGEMENT GROUP, PC
Entity type:Organization
Organization Name:ESSEX PAIN MANAGEMENT GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:201-968-1055
Mailing Address - Street 1:PO BOX 15262
Mailing Address - Street 2:C/O WACHOVIA BANK
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07192-5262
Mailing Address - Country:US
Mailing Address - Phone:201-968-1055
Mailing Address - Fax:201-968-1054
Practice Address - Street 1:165 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-7124
Practice Address - Country:US
Practice Address - Phone:201-968-1055
Practice Address - Fax:201-968-1054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096578Medicare PIN