Healthcare Provider Details

I. General information

NPI: 1275053589
Provider Name (Legal Business Name): IHEAL PAIN CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 W 32ND ST
NEW YORK NY
10001-3816
US

IV. Provider business mailing address

PO BOX 300
EDGEWATER NJ
07020-0300
US

V. Phone/Fax

Practice location:
  • Phone: 855-443-2544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: JIGNYASA DESAI
Title or Position: OWNER
Credential: DO
Phone: 201-342-1205