Provider Demographics
NPI:1710308887
Name:INTERVENTIONAL PAIN MANAGEMENT, P.C.
Entity Type:Organization
Organization Name:INTERVENTIONAL PAIN MANAGEMENT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:POONIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-952-5533
Mailing Address - Street 1:26 THROCKMORTON LN
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2520
Mailing Address - Country:US
Mailing Address - Phone:732-952-5533
Mailing Address - Fax:732-707-4732
Practice Address - Street 1:668 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6305
Practice Address - Country:US
Practice Address - Phone:718-499-4995
Practice Address - Fax:718-499-4851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269042208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty