Healthcare Provider Details

I. General information

NPI: 1962664169
Provider Name (Legal Business Name): MINIMALLY INVASIVE SPINE INSTITUTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2008
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 N GEORGE MASON DR SUITE 202
ARLINGTON VA
22205-3609
US

IV. Provider business mailing address

1508 GENESEE ST
UTICA NY
13502-5178
US

V. Phone/Fax

Practice location:
  • Phone: 703-894-2224
  • Fax: 703-997-2566
Mailing address:
  • Phone: 315-798-8737
  • Fax: 315-732-1702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ZAIN HAIDER
Title or Position: DIRECTOR
Credential: MSBM
Phone: 315-798-8737