NPIMap

Organization Active NPI

Garden State Sports & Pain Medicine, LLC

  • Pain Medicine (Anesthesiology) Physician
  • Clifton, NJ
National Provider Identifier
1821580747
Registry record updated Nov 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
GARDEN STATE SPORTS & PAIN MEDICINE, LLC
Practice address
721 Clifton Ave Ste 2D
Clifton, NJ 07013-1880
Phone
(914) 666-8866
NPI assigned
Jun 6, 2018
Last updated
Nov 2, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2020

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

Authorized official

Name
Dr. Todd S. Koppel, MDNPI 1932109170
Title
President
Phone
(914) 666-8866

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 Primary

Addresses

Primary practice location

721 Clifton Ave Ste 2D
Clifton, NJ 07013-1880

Mailing address

480 Bedford Rd Ste 4202
Chappaqua, NY 10514-1716
Phone (914) 666-8866

Other names 1

  • Premier Pain and Spine Solutions, LLC Former legal business name

National Provider Directory

National Provider Directory

Locations

240 Williamson St
Ste 205
Elizabeth, NJ 07202
Phone (908) 289-2070

480 Bedford Rd
Ste 4202
Chappaqua, NY 10514
Phone (914) 244-8762

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1528243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604275200000",
    "number": "1821580747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 BEDFORD RD STE 4202",
            "city": "CHAPPAQUA",
            "state": "NY",
            "postal_code": "105141716",
            "telephone_number": "914-666-8866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 CLIFTON AVE STE 2D",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070131880",
            "telephone_number": "914-666-8866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARDEN STATE SPORTS & PAIN MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-06",
        "last_updated": "2020-11-02",
        "certification_date": "2020-11-02",
        "status": "A",
        "authorized_official_last_name": "KOPPEL",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "914-666-8866",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Pain and Spine Solutions, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Clifton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 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.