Organization Active NPI

Pain Relief Center of America, Inc

  • Pain Medicine (Anesthesiology) Physician
  • West New York, NJ
National Provider Identifier
1780766493
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
0400146384 Issued in NJ
Legal business name
PAIN RELIEF CENTER OF AMERICA, INC
Practice address
211 60TH St
2ND Floor
West New York, NJ 07093-2805
Phone
(201) 869-3000
Fax
(201) 869-3001
NPI assigned
Oct 20, 2006
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
Jose Roque
Title
President
Phone
(201) 869-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207LP2900X 0400146384 NJ Primary

Addresses

Primary practice location

211 60TH St
2ND Floor
West New York, NJ 07093-2805

Mailing address

211 60TH St
2ND Floor
West New York, NJ 07093-2805
Phone (201) 869-3000

Other identifiers 2

IdentifierTypeStateIssuer
1629188503OtherNPI
77331001MedicaidNJ

National Provider Directory

National Provider Directory

Locations

211 60th St
#2
West New York, NJ 07093
Phone (201) 792-9081

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780766493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 60TH ST",
            "address_2": "2ND FLOOR",
            "city": "WEST NEW YORK",
            "state": "NJ",
            "postal_code": "070932805",
            "telephone_number": "201-869-3000",
            "fax_number": "201-869-3001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 60TH ST",
            "address_2": "2ND FLOOR",
            "city": "WEST NEW YORK",
            "state": "NJ",
            "postal_code": "070932805",
            "telephone_number": "201-869-3000",
            "fax_number": "201-869-3001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN RELIEF CENTER OF AMERICA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROQUE",
        "authorized_official_first_name": "JOSE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-869-3000"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NJ",
            "license": "0400146384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1629188503",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77331001",
            "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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.