Healthcare Provider Details

I. General information

NPI: 1114253366
Provider Name (Legal Business Name): SPINAL ATRS INSTITUTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11412 GEORGETOWN PIKE
GREAT FALLS VA
22066-1316
US

IV. Provider business mailing address

2208 GENESEE ST
UTICA NY
13502-5809
US

V. Phone/Fax

Practice location:
  • Phone: 877-647-4638
  • Fax: 866-611-9908
Mailing address:
  • Phone: 315-798-8737
  • Fax: 315-797-6346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

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