Provider Demographics
NPI:1972996254
Name:RIVERVIEW PAIN AND SPINE INSTITUTE PC
Entity Type:Organization
Organization Name:RIVERVIEW PAIN AND SPINE INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DINASH
Authorized Official - Middle Name:
Authorized Official - Last Name:YANAMADULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-316-0850
Mailing Address - Street 1:123 FRANKLIN CORNER RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2526
Mailing Address - Country:US
Mailing Address - Phone:609-512-1690
Mailing Address - Fax:
Practice Address - Street 1:725 RIVER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1171
Practice Address - Country:US
Practice Address - Phone:609-512-1690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07339500208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty