# FAIR LAWN PAIN MANAGEMENT LLC

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

## Provider details

- **NPI number:** 1366826778
- **Authorized official:** VIJAY GUPTA MD (PRESIDENT)
- **Authorized official phone:** (973) 777-5444

## Contact information

- **Practice address:** 28-06 BROADWAY, FAIR LAWN, NJ 07410-3913
- **Practice address phone:** (201) 475-8940
- **Mailing address:** 1117 ROUTE 46, SUITE 201, CLIFTON, NJ 07013-2449
- **Mailing address phone:** (973) 777-5444

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | 25MA08578900 | NJ | Yes |

## Other

- **Enumeration date:** 07/15/2015
- **Last updated:** 07/15/2015