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General NPI Number Information
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NPI Number | 1740529080
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Entity Type | Organization
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Legal Business Name | PRINCETON PAIN AND SPINE INSTITUTE PC
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Dates
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Enumeration Date | 02/06/2013
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 123 FRANKLIN CORNER RD SUITE 104
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-2526
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Country | US
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Telephone | 386-316-0850
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Fax | 267-639-6651
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Provider Business Mailing Address
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Address Line | 123 FRANKLIN CORNER RD SUITE 104
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-2526
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DINASH YANAMADULA
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Credential | MD
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Telephone | 386-316-0850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 25MA07339500
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License Number State | NJ
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