Organization
ANTHEM PAIN LLC
Active
Organization
ANTHEM PAIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANTI EPPANAPALLY MD (CEO)
(973) 941-2961
Entity
Organization
Contact information
Practice address
1 YALE CT, LIVINGSTON, NJ 07039-1519
(973) 941-2961
Mailing address
PO BOX 4224, CLIFTON, NJ 07012-8224
(973) 941-2961
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25MA06866400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MA06866400
LIC
NJ
Enumeration date
12/16/2016
Last updated
12/16/2016
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