Provider Demographics
NPI:1982031464
Name:FLORIDA PAIN & REHABILITATION INSTITUTE INC
Entity Type:Organization
Organization Name:FLORIDA PAIN & REHABILITATION INSTITUTE INC
Other - Org Name:FLORIDA PAIN AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-622-5766
Mailing Address - Street 1:5365 W ATLANTIC AVE
Mailing Address - Street 2:SUITE 504
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8172
Mailing Address - Country:US
Mailing Address - Phone:561-241-9300
Mailing Address - Fax:561-241-9339
Practice Address - Street 1:440 SW PERIMETER GLN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-0497
Practice Address - Country:US
Practice Address - Phone:386-719-9663
Practice Address - Fax:866-300-2394
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA PAIN AND REHABILITATION ASSOCIATES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-30
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1096512081P2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34259Medicare PIN
FL34259BMedicare PIN
FL34259AMedicare PIN