Healthcare Provider Details

I. General information

NPI: 1699471250
Provider Name (Legal Business Name): INNOVATIVE PAIN AND SPINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2271 NJ HWY 33 SUITE 103
HAMILTON NJ
08690
US

IV. Provider business mailing address

2271 NJ HWY 33 SUITE 103
HAMILTON NJ
08690
US

V. Phone/Fax

Practice location:
  • Phone: 609-890-4080
  • Fax: 609-890-4090
Mailing address:
  • Phone: 609-890-4080
  • Fax: 609-890-4090

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: ADAM SACKSTEIN
Title or Position: FOUNDER
Credential: MD
Phone: 609-605-4370