Healthcare Provider Details

I. General information

NPI: 1902172596
Provider Name (Legal Business Name): INTERVENTIONAL PAIN CARE CENTER PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CLINT MOORE RD
BOCA RATON FL
33487-2768
US

IV. Provider business mailing address

1601 CLINT MOORE RD
BOCA RATON FL
33487-2768
US

V. Phone/Fax

Practice location:
  • Phone: 908-653-9399
  • Fax: 908-653-9305
Mailing address:
  • Phone: 908-653-9399
  • Fax: 908-653-9305

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: PETER WARHEIT
Title or Position: OWNER
Credential: MD
Phone: 908-653-9399