Provider Demographics
NPI:1952694978
Name:LASER SPINE & PAIN INSTITUTE LLC
Entity Type:Organization
Organization Name:LASER SPINE & PAIN INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUKDEB
Authorized Official - Middle Name:
Authorized Official - Last Name:DATTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-479-4692
Mailing Address - Street 1:90 PARK AVE
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1301
Mailing Address - Country:US
Mailing Address - Phone:212-430-0312
Mailing Address - Fax:212-430-0412
Practice Address - Street 1:90 PARK AVE
Practice Address - Street 2:SUITE 1700
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1301
Practice Address - Country:US
Practice Address - Phone:212-430-0312
Practice Address - Fax:212-430-0412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259015-1208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty