Organization
MILLENNIUM PAIN MANAGEMENT CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAMAL M DIAB M.D. (PRESIDENT)
(973) 219-2532
Entity
Organization
Contact information
Practice address
14 RIDGEDALE AVE, SUITE 120, CEDAR KNOLLS, NJ 07927-1106
(973) 219-2532
Mailing address
PO BOX 569, DENVILLE, NJ 07834-0569
(973) 219-2532
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MA47466
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070094
MEDICARE GROUP
NJ
Enumeration date
10/15/2007
Last updated
12/20/2010
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