NPIMap

Organization Active NPI

Pain Management Institute PA

  • Anesthesiology Physician
  • Elmwood Park, NJ
National Provider Identifier
1780989087
Registry record updated Mar 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
PAIN MANAGEMENT INSTITUTE PA
Practice address
619 River Dr
Elmwood Park, NJ 07407-1317
Phone
(614) 553-0964
NPI assigned
Jan 18, 2011
Last updated
Mar 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2025

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

Authorized official

Name
Jay Tendler, MDNPI 1700804838
Title
President
Phone
(800) 738-1659

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
Anesthesiology Physician 207L00000X Primary

Addresses

Primary practice location

619 River Dr
Elmwood Park, NJ 07407-1317

Mailing address

PO Box 986520
Dept 160
Boston, MA 02298-6520
Phone (207) 784-2554

Other practice location 1

475 Prospect Ave
West Orange, NJ 07052
Phone (973) 325-6716

Other identifiers 1

IdentifierTypeStateIssuer
0556505MedicaidNJ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050314000865 NJ Part B Supplier - Clinic/Group Practice 0042265969 Receives reassigned benefits from 22 practitioners
Practice locations: East Brunswick, NJ; Elmwood Park, NJ; Toms River, NJ

National Provider Directory

National Provider Directory

Locations

562 Easton Ave
Somerset, NJ 08873
Phone (732) 565-5455

Practitioners & affiliated clinicians

Practitioners 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1295308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741046400000",
    "number": "1780989087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 986520",
            "address_2": "DEPT 160",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022986520",
            "telephone_number": "207-784-2554",
            "fax_number": "207-777-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 RIVER DR",
            "city": "ELMWOOD PARK",
            "state": "NJ",
            "postal_code": "074071317",
            "telephone_number": "614-553-0964"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "475 Prospect Ave",
            "address_purpose": "LOCATION",
            "city": "West Orange",
            "state": "NJ",
            "postal_code": "07052",
            "country_code": "US",
            "telephone_number": "973-325-6716",
            "fax_number": "704-871-2128",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PAIN MANAGEMENT INSTITUTE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-18",
        "last_updated": "2025-03-04",
        "certification_date": "2025-03-04",
        "status": "A",
        "authorized_official_last_name": "TENDLER",
        "authorized_official_first_name": "JAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "800-738-1659",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0556505",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elmwood Park, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2025; 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.