Provider Demographics
NPI:1497342794
Name:TRISTATE INTERVENTIONAL PAIN AND REGENERATIVE MEDICINE
Entity type:Organization
Organization Name:TRISTATE INTERVENTIONAL PAIN AND REGENERATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TANUJ
Authorized Official - Middle Name:
Authorized Official - Last Name:PALVIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-324-3366
Mailing Address - Street 1:162 16TH ST APT 9A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-8711
Mailing Address - Country:US
Mailing Address - Phone:336-324-3366
Mailing Address - Fax:
Practice Address - Street 1:561 ROUTE 1
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-4400
Practice Address - Country:US
Practice Address - Phone:732-894-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty