=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790271906
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INVO PAIN MEDICINE GROUP,PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2018
-----------------------------------------------------
Last Update Date | 01/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 E 46TH ST RM 304
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10017-9286
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-679-1100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 326
-----------------------------------------------------
City | RIVER EDGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07661-0326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | NILUFER GULEYUPOGLU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 646-679-1100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 225538
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------