Provider Demographics
NPI:1043764269
Name:INTERVENTIONAL PAIN AND SPINE INSTITUTE INC
Entity Type:Organization
Organization Name:INTERVENTIONAL PAIN AND SPINE INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAJAKTA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVHAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-476-8971
Mailing Address - Street 1:9 MONTICELLO CT
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-4162
Mailing Address - Country:US
Mailing Address - Phone:732-444-8888
Mailing Address - Fax:732-515-4000
Practice Address - Street 1:1907 OAK TREE RD STE 102
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2070
Practice Address - Country:US
Practice Address - Phone:732-884-7246
Practice Address - Fax:800-754-7408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Multi-Specialty