Provider Demographics
NPI:1720393226
Name:CENTER FOR SPINE INTERVENTION & PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:CENTER FOR SPINE INTERVENTION & PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGEI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGULIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-566-7467
Mailing Address - Street 1:2117 OAK TREE RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1422
Mailing Address - Country:US
Mailing Address - Phone:732-556-7467
Mailing Address - Fax:732-994-0320
Practice Address - Street 1:2117 OAK TREE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1422
Practice Address - Country:US
Practice Address - Phone:732-556-7467
Practice Address - Fax:732-994-0320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08116500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ143043A3RMedicare UPIN