Provider Demographics
NPI:1881385961
Name:INTERVENTIONAL AND FUNCTIONAL PAIN CENTER
Entity type:Organization
Organization Name:INTERVENTIONAL AND FUNCTIONAL PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICAL
Authorized Official - Prefix:
Authorized Official - First Name:BLANKI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERUBINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-351-6200
Mailing Address - Street 1:1150 RESERVOIR AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6043
Mailing Address - Country:US
Mailing Address - Phone:401-648-6100
Mailing Address - Fax:401-732-3741
Practice Address - Street 1:1150 RESERVOIR AVE STE 200
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6043
Practice Address - Country:US
Practice Address - Phone:401-648-6100
Practice Address - Fax:401-732-3741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies