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General NPI Number Information
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NPI Number | 1477953313
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL PAIN CLINIC PC
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Dates
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Enumeration Date | 08/28/2014
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Last Update Date | 10/16/2014
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Provider Practice Location Address
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Address Line | 5195 SEVEN BRIDGE ROAD
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City | EAST STROUDSBERG
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State | PA
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Zip | 18301-3006
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Country | US
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Telephone | 570-216-5475
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Fax | 570-216-5476
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Provider Business Mailing Address
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Address Line | 5195 SEVEN BRIDGE ROAD
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City | EAST STROUDSBERG
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State | PA
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Zip | 18301-3006
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Country | US
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Telephone | 570-216-5475
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Fax | 570-216-5476
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PRAVINKUMAR P PATEL
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Credential | M.D.
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Telephone | 570-216-5475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD037051L
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License Number State | PA
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