Organization Active NPI

Pain Relief Center PA

  • Pain Medicine (Anesthesiology) Physician
  • West New York, NJ
National Provider Identifier
1770689192
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
25MA06482500 Issued in NJ
Legal business name
PAIN RELIEF CENTER PA
Practice address
211 60TH Street
West New York, NJ 07093
Phone
(201) 662-5437
Fax
(201) 662-7195
NPI assigned
Sep 15, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Felix Eduardo Roque, MDNPI 1366506495
Title
President
Phone
(201) 662-5437

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207LP2900X 25MA06482500 NJ Primary

Addresses

Primary practice location

211 60TH Street
West New York, NJ 07093

Mailing address

PO Box 999
Cliffside Park, NJ 07010-0999
Phone (201) 662-5437

Other identifiers 1

IdentifierTypeStateIssuer
7067607MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040514000459 NJ Part B Supplier - Clinic/Group Practice 5890785562 Receives reassigned benefits from 10 practitioners
Practice locations: Union City, NJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770689192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 999",
            "city": "CLIFFSIDE PARK",
            "state": "NJ",
            "postal_code": "070100999",
            "telephone_number": "201-662-5437",
            "fax_number": "201-662-7195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 60TH STREET",
            "city": "WEST NEW YORK",
            "state": "NJ",
            "postal_code": "07093",
            "telephone_number": "201-662-5437",
            "fax_number": "201-662-7195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN RELIEF CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROQUE",
        "authorized_official_first_name": "FELIX",
        "authorized_official_middle_name": "EDUARDO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-662-5437",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NJ",
            "license": "25MA06482500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7067607",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West New York, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.