NJ Interventional Pain Management LLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

Legal business name

NJ INTERVENTIONAL PAIN MANAGEMENT LLC

Practice address

560 Hudson St Ste 301
Hackensack, NJ 07601-6655

Phone

(201) 641-2125

Fax

(201) 630-8831

NPI assigned

Jul 15, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Fenar Themistocle, MD

Title

Owner

Phone

(201) 630-8831

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574812800000",
    "number": "1225680796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 HUDSON ST STE 301",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076016655",
            "telephone_number": "201-641-2125",
            "fax_number": "201-630-8831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 HUDSON ST STE 301",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076016655",
            "telephone_number": "201-641-2125",
            "fax_number": "201-630-8831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NJ INTERVENTIONAL PAIN MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-15",
        "last_updated": "2019-11-27",
        "status": "A",
        "authorized_official_last_name": "THEMISTOCLE",
        "authorized_official_first_name": "FENAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-630-8831",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUSINESS REGISTRATION",
            "identifier": "0450398638",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Interventional Pain Medicine Physician in Hackensack, NJ
• Providers in Hackensack, NJ by specialty
• Interventional Pain Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.