Provider Demographics
NPI:1831363159
Name:INTERVENTIONAL PAIN SOLUTIONS, PLLC
Entity type:Organization
Organization Name:INTERVENTIONAL PAIN SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-208-7240
Mailing Address - Street 1:670 N BEERS ST
Mailing Address - Street 2:BLDG 2, STE 1
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1516
Mailing Address - Country:US
Mailing Address - Phone:732-226-6603
Mailing Address - Fax:888-500-0606
Practice Address - Street 1:670 N BEERS ST
Practice Address - Street 2:BLDG 2, STE 1
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1516
Practice Address - Country:US
Practice Address - Phone:732-226-6603
Practice Address - Fax:888-500-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2476042081P2900X
NJ25MA08003800208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI15183Medicare UPIN