Basic Information
| Provider Information | |||||||||
| NPI: | 1104352335 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADVANCED SPINE AND PAIN, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RELIEVUS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 375 E ELM ST | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | CONSHOHOCKEN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194281973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9083709104 | ||||||||
| FaxNumber: | 4842127641 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 8TH ST | ||||||||
| Address2: | |||||||||
| City: | HAMMONTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080373347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889852727 | ||||||||
| FaxNumber: | 4842127641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2017 | ||||||||
| LastUpdateDate: | 05/09/2017 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | NIRALI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9083709104 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHARMD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | 25MA09802600 | NJ | Y | Suppliers | Non-Pharmacy Dispensing Site |
No ID Information.