Organization
MOUNTAINSIDE PAIN MANAGEMENT PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN WALTON SECOY MD (PRESIDENT OF CORPORATION)
(973) 226-1230
Entity
Organization
Contact information
Practice address
185 FAIRFIELD AVE STE 2A, WEST CALDWELL, NJ 07006-6417
(973) 226-1230
Mailing address
185 FAIRFIELD AVE STE 2A, WEST CALDWELL, NJ 07006-6417
(973) 226-1230
(973) 226-1232
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
725433
PTAN
NJ
Enumeration date
01/29/2019
Last updated
04/01/2019
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