Organization

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)

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

Provider Address