MEDICARE: CENTER FOR SPINE INTERVENTION & PAIN MANAGEMENT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	25MA08116500	NJ

General Provider Information

NPI Number	:	1720393226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR SPINE INTERVENTION & PAIN MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	2117 OAK TREE RD
Second Line	:	SUITE 209
City	:	EDISON
State	:	NJ
Zip	:	08820-1422
Country	:	US
Telephone Number	:	732-556-7467
Fax Number	:	732-994-0320

Provider Business Practice Location Address
First Line	:	2117 OAK TREE RD
Second Line	:	SUITE 209
City	:	EDISON
State	:	NJ
Zip	:	08820-1422
Country	:	US
Telephone Number	:	732-556-7467
Fax Number	:	732-994-0320

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. SERGEI MARGULIAN
Credential	:	M.D.
Telephone Number	:	732-566-7467

Provider Enumeration Date	:	08/10/2010
Last Update Date	:	08/10/2010

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