Provider Demographics
NPI:1689319865
Name:STOP PAIN PA
Entity Type:Organization
Organization Name:STOP PAIN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIBIRCEVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-913-5521
Mailing Address - Street 1:13554 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-3233
Mailing Address - Country:US
Mailing Address - Phone:917-913-5521
Mailing Address - Fax:
Practice Address - Street 1:13554 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-3233
Practice Address - Country:US
Practice Address - Phone:917-913-5521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty