MEDICARE: ADVANCED INTERVENTIONAL PAIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0000X	Pain Medicine Physician	25MA08897700	NJ

General Provider Information

NPI Number	:	1134488125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED INTERVENTIONAL PAIN

Provider Business Mailing Address
First Line	:	3848 PARK AVE
Second Line	:	SUITE 101
City	:	EDISON
State	:	NJ
Zip	:	08820-2508
Country	:	US
Telephone Number	:	732-952-5533
Fax Number	:	732-707-4732

Provider Business Practice Location Address
First Line	:	3848 PARK AVE STE 101
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08820-2508
Country	:	US
Telephone Number	:	732-952-5533
Fax Number	:	732-707-4732

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. AMIT POONIA
Credential	:	M.D.
Telephone Number	:	732-952-5533

Provider Enumeration Date	:	05/10/2012
Last Update Date	:	07/21/2022

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Directions to “ADVANCED INTERVENTIONAL PAIN ” Practice Location

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