Provider Demographics
NPI:1558304212
Name:BRAIN & SPINE NEUROSURGICAL INSTITUTE, LLC
Entity Type:Organization
Organization Name:BRAIN & SPINE NEUROSURGICAL INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMIT
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:DAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-270-5395
Mailing Address - Street 1:25 THURBER BLVD
Mailing Address - Street 2:UNIT 6
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-1816
Mailing Address - Country:US
Mailing Address - Phone:401-404-2975
Mailing Address - Fax:404-404-2976
Practice Address - Street 1:1526 ATWOOD AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919
Practice Address - Country:US
Practice Address - Phone:401-270-5395
Practice Address - Fax:401-270-7635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISD50629Medicaid
RI149024159Medicare PIN
5532470001Medicare NSC