Organization
BAYONNE PAIN MANAGEMENT CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAMDOUH S HANNA MD (MD / OWNER)
(201) 303-7700
Entity
Organization
Contact information
Practice address
631 BROADWAY, BAYONNE, NJ 07002-3846
(201) 471-7246
(201) 471-7242
Mailing address
631 BROADWAY, BAYONNE, NJ 07002-3846
(201) 471-7246
(201) 471-7242
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
APPLIED
—
NJ
Enumeration date
09/17/2018
Last updated
09/17/2018
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