Provider Demographics
NPI:1780157222
Name:ADVANCED SPINE AND PAIN LLC
Entity type:Organization
Organization Name:ADVANCED SPINE AND PAIN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAMEAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:FREAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-985-2727
Mailing Address - Street 1:201 DEFENSE HWY STE 205
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7096
Mailing Address - Country:US
Mailing Address - Phone:888-985-2727
Mailing Address - Fax:856-779-0211
Practice Address - Street 1:40 BEY LEA RD STE C203
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2974
Practice Address - Country:US
Practice Address - Phone:888-985-2727
Practice Address - Fax:856-779-0211
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED SPINE AND PAIN, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-08
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty