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General NPI Number Information
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NPI Number | 1215997929
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Entity Type | Organization
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Legal Business Name | HARRISBURG INTERVENTIONAL PAIN MGMT CTR
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Dates
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Enumeration Date | 03/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 825 SIR THOMAS COURT SUITE A
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City | HARRISBURG
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State | PA
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Zip | 17109
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Country | US
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Telephone | 717-901-5008
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Fax | 717-920-3261
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Provider Business Mailing Address
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Address Line | 825 SIR THOMAS COURT SUITE A
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City | HARRISBURG
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State | PA
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Zip | 17109
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Country | US
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Telephone | 717-901-5008
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Fax | 717-920-3261
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | MALIK N MOMIN
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Credential | MD
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Telephone | 717-901-5008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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