Provider Demographics
NPI:1205227030
Name:ADVANCED INTERVENTIONAL PAIN MANAGEMENT CENTER, LLC
Entity Type:Organization
Organization Name:ADVANCED INTERVENTIONAL PAIN MANAGEMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KETA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-952-5533
Mailing Address - Street 1:26 THROCKMORTON LN
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2520
Mailing Address - Country:US
Mailing Address - Phone:732-952-5533
Mailing Address - Fax:732-707-4732
Practice Address - Street 1:26 THROCKMORTON LN
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2520
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:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00356700261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain