Organization
NJ INTERVENTIONAL PAIN MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FENAR THEMISTOCLE MD (OWNER)
(201) 630-8831
Entity
Organization
Contact information
Practice address
560 HUDSON ST STE 301, HACKENSACK, NJ 07601-6655
(201) 641-2125
(201) 630-8831
Mailing address
560 HUDSON ST STE 301, HACKENSACK, NJ 07601-6655
(201) 641-2125
(201) 630-8831
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0450398638
BUSINESS REGISTRATION
NJ
Enumeration date
07/15/2019
Last updated
11/27/2019
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