Provider Demographics
NPI:1922563121
Name:THE PAIN, SPINE AND SPORTS INSTITUTE LLC
Entity Type:Organization
Organization Name:THE PAIN, SPINE AND SPORTS INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-912-9233
Mailing Address - Street 1:328 MERCER LOOP
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3233
Mailing Address - Country:US
Mailing Address - Phone:973-779-7361
Mailing Address - Fax:973-779-7385
Practice Address - Street 1:1144 E RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3941
Practice Address - Country:US
Practice Address - Phone:201-336-0188
Practice Address - Fax:201-336-0141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA09668500OtherLICENSE NUMBER