# PAIN MANAGEMENT & REJUVENATION CLINIC USA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043965163
- **Authorized official:** DR. CLARICIO DECASTRO PEGUERO MD (OWNER)
- **Authorized official phone:** (551) 204-2543

## Contact information

- **Practice address:** 1209 SUMMIT AVE UNIT 102, JERSEY CITY, NJ 07307-3170
- **Practice address phone:** (201) 714-4683
- **Practice address fax:** (201) 742-0084
- **Mailing address:** 154 ORANGEBURGH RD, OLD TAPPAN, NJ 07675-7499
- **Mailing address phone:** (201) 714-4683
- **Mailing address fax:** (201) 742-0084

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/16/2022
- **Last updated:** 10/15/2024