Basic Information
| Provider Information | |||||||||
| NPI: | 1740418748 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MINIMALLY INVASIVE SPINE AND PAIN CTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 SUNSET STRIP | ||||||||
| Address2: | SUITE 407 | ||||||||
| City: | SUCCASUNNA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078761345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732521166 | ||||||||
| FaxNumber: | 9732521177 | ||||||||
| Practice Location | |||||||||
| Address1: | 254B MOUNTAIN AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | HACKETTSTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078402413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086845800 | ||||||||
| FaxNumber: | 9086845606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2009 | ||||||||
| LastUpdateDate: | 06/29/2009 | ||||||||
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| AuthorizedOfficialLastName: | MALIK | ||||||||
| AuthorizedOfficialFirstName: | ATIF | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9732521166 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.