Provider Demographics
NPI:1861612483
Name:FLORIDA PAIN & REHABILITATION INSTITUTE INC
Entity type:Organization
Organization Name:FLORIDA PAIN & REHABILITATION INSTITUTE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-622-5766
Mailing Address - Street 1:5365 W ATLANTIC AVE
Mailing Address - Street 2:SUITE 504
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8172
Mailing Address - Country:US
Mailing Address - Phone:561-241-9300
Mailing Address - Fax:561-241-9339
Practice Address - Street 1:150 SW CHAMBER CT
Practice Address - Street 2:STE 105
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3413
Practice Address - Country:US
Practice Address - Phone:772-807-9000
Practice Address - Fax:772-807-9087
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA PAIN & REHABILITATION ASSOC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-26
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57494208100000X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4273890006Medicare NSC
FL34259Medicare PIN
FL34259Medicare PIN