Provider Demographics
NPI:1669002697
Name:BHUPINDER SINGH BOLLA MD PLLC
Entity Type:Organization
Organization Name:BHUPINDER SINGH BOLLA MD PLLC
Other - Org Name:PAIN SOLUTIONS OF NORTHERN NEW YORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BHUPINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-782-7246
Mailing Address - Street 1:26561 STATE ROUTE 3 STE A
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-1749
Mailing Address - Country:US
Mailing Address - Phone:315-782-7246
Mailing Address - Fax:315-782-7247
Practice Address - Street 1:26561 STATE ROUTE 3 STE A
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-1749
Practice Address - Country:US
Practice Address - Phone:315-782-7246
Practice Address - Fax:315-782-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-17
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty