Healthcare Provider Details

I. General information

NPI: 1043764269
Provider Name (Legal Business Name): INTERVENTIONAL PAIN AND SPINE INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 OAK TREE RD STE 102
EDISON NJ
08820-2070
US

IV. Provider business mailing address

9 MONTICELLO CT
MORGANVILLE NJ
07751-4162
US

V. Phone/Fax

Practice location:
  • Phone: 732-884-7246
  • Fax: 800-754-7408
Mailing address:
  • Phone: 732-444-8888
  • Fax: 732-515-4000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PRAJAKTA AVHAD
Title or Position: OWNER
Credential: MD
Phone: 732-476-8971