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Organization
ADVANCED SPINE PAIN THERAPY, LLC
Active
Organization
ADVANCED SPINE PAIN THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHINWEIKE IZEOGU MD (MEDICAL DIRECTOR)
(973) 673-0601
Entity
Organization
Contact information
Practice address
290 S LIVINGSTON AVE STE 1, LIVINGSTON, NJ 07039-3986
(973) 673-0601
(973) 533-0958
Mailing address
290 S LIVINGSTON AVE STE 1, LIVINGSTON, NJ 07039-3986
(973) 673-0601
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
NULL
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Enumeration date
11/03/2017
Last updated
11/23/2020
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