Provider Demographics
NPI:1619302288
Name:INTERSTATE MULTI-SPECIALTY MEDICAL GROUP PC
Entity Type:Organization
Organization Name:INTERSTATE MULTI-SPECIALTY MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAITSEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-574-2070
Mailing Address - Street 1:165 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-7124
Mailing Address - Country:US
Mailing Address - Phone:973-574-2070
Mailing Address - Fax:
Practice Address - Street 1:165 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-7124
Practice Address - Country:US
Practice Address - Phone:973-574-2070
Practice Address - Fax:973-574-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty