Provider Demographics
NPI:1437802790
Name:NORTHEAST PAIN SPECIALISTS LLC
Entity Type:Organization
Organization Name:NORTHEAST PAIN SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AVNER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-479-8104
Mailing Address - Street 1:414 E DRINKER ST REAR SUITE203
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-2469
Mailing Address - Country:US
Mailing Address - Phone:570-558-2050
Mailing Address - Fax:570-558-2056
Practice Address - Street 1:414 E DRINKER ST REAR SUITE203
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-2469
Practice Address - Country:US
Practice Address - Phone:570-558-2050
Practice Address - Fax:570-558-2056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty