Organization
PAIN MANAGEMENT MEDICAL ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAVI K VENKATARAMAN MD (CEO)
(973) 779-7361
Entity
Organization
Contact information
Practice address
1060 CLIFTON AVE, CLIFTON, NJ 07013-3638
(973) 779-7361
(973) 779-7385
Mailing address
PO BOX 1258, CLIFTON, NJ 07012-0758
(973) 779-7361
(973) 779-7385
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
2065821
NY
208VP0014X
Interventional Pain Medicine Physician
25MA06850700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2065821
LICENSE
NY
01
—
25MA06850700
LICENSE
NJ
01
—
7787522
STATE OF NY
NY
Enumeration date
07/30/2010
Last updated
07/03/2013
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