Provider Demographics
NPI:1831446673
Name:ADVANCED INTERVENTIONAL PAIN CONSULTANTS, LLC
Entity type:Organization
Organization Name:ADVANCED INTERVENTIONAL PAIN CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:MOHSEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MICHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-365-0008
Mailing Address - Street 1:1081 PAULISON AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-3658
Mailing Address - Country:US
Mailing Address - Phone:973-365-0008
Mailing Address - Fax:973-365-0004
Practice Address - Street 1:1081 PAULISON AVE STE 2B
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-3658
Practice Address - Country:US
Practice Address - Phone:973-365-0008
Practice Address - Fax:973-365-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-11
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07077100208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH47879Medicare UPIN