Healthcare Provider Details

I. General information

NPI: 1396074704
Provider Name (Legal Business Name): MINIMALLY INVASIVE PAIN INSTITUTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45189 RESEARCH PL SUITE 140
ASHBURN VA
20147-2694
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: 315-733-1384
  • Fax: 315-797-6346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number0101058239
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number0101058239
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD036385
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD036385
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD036385
License Number StateDC
# 6
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number0101058239
License Number StateVA

VIII. Authorized Official

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