Provider Demographics
NPI:1922338615
Name:INTERVENTIONAL PAIN MANAGEMENT & REHAB. PC.
Entity Type:Organization
Organization Name:INTERVENTIONAL PAIN MANAGEMENT & REHAB. PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NASAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAHID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-697-4358
Mailing Address - Street 1:179 CEDAR LN STE F
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4304
Mailing Address - Country:US
Mailing Address - Phone:201-907-5094
Mailing Address - Fax:201-907-0031
Practice Address - Street 1:179 CEDAR LN STE F
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4304
Practice Address - Country:US
Practice Address - Phone:201-907-5094
Practice Address - Fax:201-907-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00468200111N00000X
NJ25MA07393900208100000X, 2081P2900X
NY216092208100000X, 2081P0004X, 2081P2900X
NJ25MA0703939002081P0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty