Provider Demographics
NPI:1649537101
Name:INTERDISCIPLINARY PAIN THERAPY ASSOCIATES, L.L.C.
Entity type:Organization
Organization Name:INTERDISCIPLINARY PAIN THERAPY ASSOCIATES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FUOCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-391-3266
Mailing Address - Street 1:5 TENNYSON PL
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-5444
Mailing Address - Country:US
Mailing Address - Phone:985-869-0271
Mailing Address - Fax:
Practice Address - Street 1:5 TENNYSON PL
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-5444
Practice Address - Country:US
Practice Address - Phone:985-869-0271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health