Provider Demographics
NPI:1144970419
Name:TRI STATE SPINE AND PAIN PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:TRI STATE SPINE AND PAIN PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARTAMONOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-972-6778
Mailing Address - Street 1:596 ANDERSON AVE STE 216
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1856
Mailing Address - Country:US
Mailing Address - Phone:551-277-2071
Mailing Address - Fax:561-529-5144
Practice Address - Street 1:596 ANDERSON AVE STE 216
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-1856
Practice Address - Country:US
Practice Address - Phone:551-277-2071
Practice Address - Fax:561-529-5144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty