# ADVANCED SPINE PAIN THERAPY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538671268
- **Authorized official:** DR. CHINWEIKE IZEOGU MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (973) 673-0601

## Contact information

- **Practice address:** 290 S LIVINGSTON AVE STE 1, LIVINGSTON, NJ 07039-3986
- **Practice address phone:** (973) 673-0601
- **Practice address fax:** (973) 533-0958
- **Mailing address:** 290 S LIVINGSTON AVE STE 1, LIVINGSTON, NJ 07039-3986
- **Mailing address phone:** (973) 673-0601

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/03/2017
- **Last updated:** 11/23/2020