Healthcare Provider Details

I. General information

NPI: 1336684182
Provider Name (Legal Business Name): FLORIDA PAIN & REHABILITATION INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 08/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 S HARBOR CITY BLVD STE A
MELBOURNE FL
32901-1500
US

IV. Provider business mailing address

5365 W ATLANTIC AVE STE 504
DELRAY BEACH FL
33484-8194
US

V. Phone/Fax

Practice location:
  • Phone: 321-733-0064
  • Fax: 321-733-7970
Mailing address:
  • Phone: 561-241-9300
  • Fax: 561-241-9339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME109651
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME109651
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME109651
License Number StateFL

VIII. Authorized Official

Name: CHERIAN SAJAN
Title or Position: OWNER
Credential: MD
Phone: 407-622-5766