Provider Demographics
NPI:1669787180
Name:INNOVATION SPINE MEDICAL PC
Entity type:Organization
Organization Name:INNOVATION SPINE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLINT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-599-3999
Mailing Address - Street 1:4 WEBER AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1742
Mailing Address - Country:US
Mailing Address - Phone:516-599-3999
Mailing Address - Fax:516-887-8106
Practice Address - Street 1:4 WEBER AVE
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1742
Practice Address - Country:US
Practice Address - Phone:516-599-3999
Practice Address - Fax:516-887-8106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty