Provider Demographics
NPI:1043965163
Name:PAIN MANAGEMENT & REJUVENATION CLINIC USA
Entity type:Organization
Organization Name:PAIN MANAGEMENT & REJUVENATION CLINIC USA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARICIO
Authorized Official - Middle Name:DECASTRO
Authorized Official - Last Name:PEGUERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:551-204-2543
Mailing Address - Street 1:154 ORANGEBURGH RD
Mailing Address - Street 2:
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-7499
Mailing Address - Country:US
Mailing Address - Phone:201-714-4683
Mailing Address - Fax:201-742-0084
Practice Address - Street 1:1209 SUMMIT AVE UNIT 102
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-3170
Practice Address - Country:US
Practice Address - Phone:201-714-4683
Practice Address - Fax:201-742-0084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty