Provider Demographics
NPI:1881187102
Name:ALFA SPINE AND PAIN
Entity Type:Organization
Organization Name:ALFA SPINE AND PAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:PILLARISETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-276-6293
Mailing Address - Street 1:3724 WINTER GARDEN VINELAND RD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5483
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3724 WINTER GARDEN VINELAND RD BLDG 2
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5483
Practice Address - Country:US
Practice Address - Phone:321-276-6293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1851667778OtherNPI
1548557580OtherNPI