Provider Demographics
NPI:1053749416
Name:PAIN AND NEUROPATHY CENTER OF PA PC
Entity type:Organization
Organization Name:PAIN AND NEUROPATHY CENTER OF PA PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-917-3800
Mailing Address - Street 1:181 JERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-2609
Mailing Address - Country:US
Mailing Address - Phone:973-917-3800
Mailing Address - Fax:732-228-7427
Practice Address - Street 1:181 JERSEY AVE
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-2609
Practice Address - Country:US
Practice Address - Phone:973-917-3800
Practice Address - Fax:732-228-7427
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAIN AND NEUROPATHY CENTER OF PA PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-23
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA078772002081P2900X
PAMD4235852081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI06877Medicare UPIN