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General NPI Number Information
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NPI Number | 1881158939
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Entity Type | Organization
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Legal Business Name | INTEGRA NEURO PAIN INSTITUTE PA
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Dates
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Enumeration Date | 01/23/2019
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 5979 VINELAND RD STE 114
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City | ORLANDO
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State | FL
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Zip | 32819-7855
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Country | US
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Telephone | 863-547-0788
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Fax | 863-547-0789
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Provider Business Mailing Address
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Address Line | 8297 CHAMPIONS GATE BLVD STE 463
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City | CHAMPIONS GATE
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State | FL
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Zip | 33896-8387
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Country | US
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Telephone | 863-547-0788
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Fax | 863-547-0789
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | DR. MOHAMMAD MASOOM QURESHI
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Credential | MD
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Telephone | 863-547-0788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P2900X
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Taxonomy Name | Pain Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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