Garden State Spine And Pain Institute Llc
Legal Business Name
Garden State Spine And Pain Institute Llc
NPI Number
1023196094
NPI Type
Organization
Enumeration Date
11/01/2006
Specialties
(Taxonomies)Name
Code
171100000X
111N00000X
208VP0014X
208100000X
225100000X
Primary Taxonomy
No
No
No
No
No
Licenses
State
New Jersey
New Jersey
New Jersey
New Jersey
New Jersey
New Jersey
New Jersey
New Jersey
New Mexico
License Number
25MZ00035200
25MZ00038300
38MC00542300
25MA07847300
25MA07807000
25MB07638100
40QA01192300
40QA01205100
25MZ00052600
Contact
Information
Purpose
Mailing
Location
Address
7 MERIDIAN RD
7 MERIDIAN RD
City
Eatontown
Eatontown
State
NJ
NJ
Postal Code
07724-2242
07724-2242
Country
US
US
Telephone Number
(732) 935-1000
(732) 935-1000
Authorized Official
Name
Dr. Raj Gupta
Title or Position
PARTNER/OWER
Telephone Number
(732) 935-1000
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 05/25/2011