Healthcare Provider Details

I. General information

NPI: 1174023345
Provider Name (Legal Business Name): ORLANDO PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 PALM SPRINGS DR STE A
ALTAMONTE SPRINGS FL
32701-7864
US

IV. Provider business mailing address

719 BUTTERNUT DR
FRANKLIN LAKES NJ
07417-2281
US

V. Phone/Fax

Practice location:
  • Phone: 407-339-7143
  • Fax: 888-766-8193
Mailing address:
  • Phone: 201-925-0277
  • Fax: 888-766-8193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number135793
License Number StateFL

VIII. Authorized Official

Name: VINCENTIU POPA
Title or Position: OWNER
Credential: MD
Phone: 201-925-0277