Provider Demographics
NPI:1134488125
Name:ADVANCED INTERVENTIONAL PAIN
Entity Type:Organization
Organization Name:ADVANCED INTERVENTIONAL PAIN
Other - Org Name:ADVANCED INTERVENTIONAL PAIN MANAGEMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:POONIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-952-5533
Mailing Address - Street 1:3848 PARK AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2508
Mailing Address - Country:US
Mailing Address - Phone:732-952-5533
Mailing Address - Fax:732-707-4732
Practice Address - Street 1:3848 PARK AVE STE 101
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2508
Practice Address - Country:US
Practice Address - Phone:732-952-5533
Practice Address - Fax:732-707-4732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08897700208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty