Provider Demographics
NPI:1730521360
Name:TRISTATE INTERVENTIONAL PAIN AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:TRISTATE INTERVENTIONAL PAIN AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEERAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-633-5840
Mailing Address - Street 1:2601 ANNAND DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-3719
Mailing Address - Country:US
Mailing Address - Phone:302-789-0545
Mailing Address - Fax:
Practice Address - Street 1:2601 ANNAND DR
Practice Address - Street 2:SUITE 3
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-3719
Practice Address - Country:US
Practice Address - Phone:302-789-0545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0007252208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEI07340Medicare UPIN