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General NPI Number Information
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NPI Number | 1831446673
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Entity Type | Organization
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Legal Business Name | ADVANCED INTERVENTIONAL PAIN CONSULTANTS, LLC
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Dates
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Enumeration Date | 08/11/2012
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Last Update Date | 03/13/2019
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Provider Practice Location Address
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Address Line | 1081 PAULISON AVE STE 2B
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City | CLIFTON
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State | NJ
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Zip | 07011-3658
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Country | US
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Telephone | 973-365-0008
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Fax | 973-365-0004
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Provider Business Mailing Address
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Address Line | 1081 PAULISON AVE STE 2B
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City | CLIFTON
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State | NJ
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Zip | 07011-3658
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Country | US
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Telephone | 973-365-0008
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Fax | 973-365-0004
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Authorized Official
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Title or Position | SOLE MBR
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Name | MOHSEN T MICHAIL
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Credential | M.D.
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Telephone | 973-365-0008
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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 | 25MA07077100
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License Number State | NJ
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