Organization
DESIO PAIN INSTITUTE P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOANN TIEDEMANN (BILLING AGENT)
(732) 257-5454
Entity
Organization
Contact information
Practice address
452 LAKEHURST RD, TOMS RIVER, NJ 08755-6344
(732) 349-1053
(732) 349-9092
Mailing address
PO BOX 1110, WALL, NJ 07719-1110
(732) 349-1053
(732) 349-9092
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
25MA06205300
NJ
Other
Enumeration date
01/10/2012
Last updated
01/18/2012
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