Provider Demographics
NPI:1598700999
Name:INTERVENTIONAL SPINE AND PAIN TREATMENT CENTER, PC
Entity Type:Organization
Organization Name:INTERVENTIONAL SPINE AND PAIN TREATMENT CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMNANAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-949-5009
Mailing Address - Street 1:PO BOX 604
Mailing Address - Street 2:
Mailing Address - City:SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-0604
Mailing Address - Country:US
Mailing Address - Phone:973-949-5009
Mailing Address - Fax:973-949-5010
Practice Address - Street 1:535 HIGH MOUNTAIN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:NORTH HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-2665
Practice Address - Country:US
Practice Address - Phone:973-949-5009
Practice Address - Fax:973-949-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NJ25MA04543000207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ092135Medicare ID - Type Unspecified