Provider Demographics
NPI:1588279509
Name:SPINE AND PAIN RELIEF CENTER
Entity type:Organization
Organization Name:SPINE AND PAIN RELIEF CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAED
Authorized Official - Middle Name:
Authorized Official - Last Name:HATTAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-651-3629
Mailing Address - Street 1:924 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2155
Mailing Address - Country:US
Mailing Address - Phone:201-243-6211
Mailing Address - Fax:201-455-2422
Practice Address - Street 1:924 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-2155
Practice Address - Country:US
Practice Address - Phone:201-243-6211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPINE AND PAIN RELIEF CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain