Provider Demographics
NPI:1851402127
Name:ADVANCED PHYSICAL MEDICINE & REHABILITATION LLC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL MEDICINE & REHABILITATION LLC
Other - Org Name:SPINAL & SKELETAL PAIN MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED SIGNATORY
Authorized Official - Prefix:MR
Authorized Official - First Name:NAMEER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-798-8737
Mailing Address - Street 1:110 BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6307
Mailing Address - Country:US
Mailing Address - Phone:315-798-8737
Mailing Address - Fax:315-732-1702
Practice Address - Street 1:110 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6307
Practice Address - Country:US
Practice Address - Phone:315-798-8737
Practice Address - Fax:315-732-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0236681Medicaid
CG9418OtherPALMETTO RRB MEDICARE
NY0236681Medicaid
NY0236681Medicaid
NY=========OtherTIN