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General NPI Number Information
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NPI Number | 1972630788
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Entity Type | Organization
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Legal Business Name | NEW JERSEY SPINE AND PAIN INSTITUTE LLC
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 19 E 27TH ST
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City | BAYONNE
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State | NJ
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Zip | 07002-4608
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Country | US
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Telephone | 201-436-0033
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Fax | 201-436-0079
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Provider Business Mailing Address
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Address Line | 19 E 27TH ST
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City | BAYONNE
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State | NJ
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Zip | 07002-4608
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Country | US
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Telephone | 201-436-0033
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Fax | 201-436-0079
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH G. A. IBRAHIM
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Credential | MD
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Telephone | 201-436-0033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 25MA07777500
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License Number State | NJ
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