Provider Demographics
NPI:1700048428
Name:INTERVENTIONAL PAIN MEDICINE LLC.
Entity Type:Organization
Organization Name:INTERVENTIONAL PAIN MEDICINE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHSEN
Authorized Official - Middle Name:AYAD
Authorized Official - Last Name:KALLINY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-390-1424
Mailing Address - Street 1:24 FOUR COLUMNS DR
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-4459
Mailing Address - Country:US
Mailing Address - Phone:732-390-1424
Mailing Address - Fax:732-390-1430
Practice Address - Street 1:24 FOUR COLUMNS DR
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-4459
Practice Address - Country:US
Practice Address - Phone:732-390-1424
Practice Address - Fax:732-390-1430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07064000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty