Provider Demographics
NPI:1548675879
Name:TRISTATE SPINE AND PAIN LLC
Entity type:Organization
Organization Name:TRISTATE SPINE AND PAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SEKHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-849-9500
Mailing Address - Street 1:63 LACEY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-2966
Mailing Address - Country:US
Mailing Address - Phone:732-849-9500
Mailing Address - Fax:732-849-9501
Practice Address - Street 1:63 LACEY RD
Practice Address - Street 2:SUITE C
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-2966
Practice Address - Country:US
Practice Address - Phone:732-849-9500
Practice Address - Fax:732-849-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09282300207LP2900X
NJ25MA08297000207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty