# DESIO PAIN INSTITUTE P.A.

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

## Provider details

- **NPI number:** 1295005122
- **Authorized official:** JOANN TIEDEMANN (BILLING AGENT)
- **Authorized official phone:** (732) 257-5454

## Contact information

- **Practice address:** 452 LAKEHURST RD, TOMS RIVER, NJ 08755-6344
- **Practice address phone:** (732) 349-1053
- **Practice address fax:** (732) 349-9092
- **Mailing address:** PO BOX 1110, WALL, NJ 07719-1110
- **Mailing address phone:** (732) 349-1053
- **Mailing address fax:** (732) 349-9092

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208VP0000X | Pain Medicine Physician | 25MA06205300 | NJ | Yes |

## Other

- **Enumeration date:** 01/10/2012
- **Last updated:** 01/18/2012