Healthcare Provider Details

I. General information

NPI: 1922338615
Provider Name (Legal Business Name): INTERVENTIONAL PAIN MANAGEMENT & REHAB. PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2010
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 CEDAR LN STE F
TEANECK NJ
07666-4304
US

IV. Provider business mailing address

179 CEDAR LN STE F
TEANECK NJ
07666-4304
US

V. Phone/Fax

Practice location:
  • Phone: 201-907-5094
  • Fax: 201-907-0031
Mailing address:
  • Phone: 201-907-5094
  • Fax: 201-907-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number216092
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MA07393900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number25MA070393900
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number216092
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number25MA07393900
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number216092
License Number StateNY

VIII. Authorized Official

Name: NASAR M SHAHID
Title or Position: OWNER
Credential: MD
Phone: 201-907-5094