Fair Lawn Pain Management LLC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

25MA08578900 Issued in NJ

Legal business name

FAIR LAWN PAIN MANAGEMENT LLC

Practice address

28-06 Broadway
Fair Lawn, NJ 07410-3913

Phone

(201) 475-8940

NPI assigned

Jul 15, 2015

Organization subpart

No

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

Authorized official

Name

Vijay Gupta, MD

Title

President

Phone

(973) 777-5444

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1436918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436918400000",
    "number": "1366826778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1117 ROUTE 46",
            "address_2": "SUITE 201",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070132449",
            "telephone_number": "973-777-5444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28-06 BROADWAY",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074103913",
            "telephone_number": "201-475-8940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIR LAWN PAIN MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-15",
        "last_updated": "2015-07-15",
        "status": "A",
        "authorized_official_last_name": "GUPTA",
        "authorized_official_first_name": "VIJAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "973-777-5444",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NJ",
            "license": "25MA08578900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pain Medicine (Anesthesiology) Physician in Fair Lawn, NJ
• Providers in Fair Lawn, NJ by specialty
• Pain Medicine (Anesthesiology) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2015; 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.