=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588083125
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLORIDA PAIN & REHABILITATION INSTITUTE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2014
-----------------------------------------------------
Last Update Date | 10/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1530 CITRUS MEDICAL CT SUITE 101
-----------------------------------------------------
City | OCOEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34761-4548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-622-7246
-----------------------------------------------------
Fax | 407-599-7246
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5365 W ATLANTIC AVE SUITE 504
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33484-8172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-241-9300
-----------------------------------------------------
Fax | 561-241-9339
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHERIAN SAJAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 407-622-5766
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | ME109651
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208VP0000X
-----------------------------------------------------
Taxonomy Name | Pain Medicine Physician
-----------------------------------------------------
License Number | ME109651
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number | ME109651
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------