Healthcare Provider Details

I. General information

NPI: 1598700999
Provider Name (Legal Business Name): INTERVENTIONAL SPINE AND PAIN TREATMENT CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 HIGH MOUNTAIN RD SUITE 202
NORTH HALEDON NJ
07508-2665
US

IV. Provider business mailing address

PO BOX 604
SADDLE RIVER NJ
07458-0604
US

V. Phone/Fax

Practice location:
  • Phone: 973-949-5009
  • Fax: 973-949-5010
Mailing address:
  • Phone: 973-949-5009
  • Fax: 973-949-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA04543000
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number25MA04543000
License Number StateNJ

VIII. Authorized Official

Name: TERRY RAMNANAN
Title or Position: OWNER
Credential: MD
Phone: 973-949-5009