Provider Demographics
NPI:1790092203
Name:BOSTON INTERVENTIONAL PAIN GROUP, PLLC
Entity Type:Organization
Organization Name:BOSTON INTERVENTIONAL PAIN GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:
Authorized Official - Last Name:FARID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-333-0449
Mailing Address - Street 1:9524 W CAMELBACK RD
Mailing Address - Street 2:SUITE 130 PMB#165
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-3104
Mailing Address - Country:US
Mailing Address - Phone:623-210-5156
Mailing Address - Fax:623-218-9129
Practice Address - Street 1:14044 W CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-9428
Practice Address - Country:US
Practice Address - Phone:623-210-5156
Practice Address - Fax:623-218-9129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43561174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty