Healthcare Provider Details

I. General information

NPI: 1255107009
Provider Name (Legal Business Name): INTERVENTIONAL PAIN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 VIA DE PALMAS
BOCA RATON FL
33432-6007
US

IV. Provider business mailing address

307 VIA DE PALMAS
BOCA RATON FL
33432-6007
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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