# INTERVENTIONAL SPINE & SPORTS MEDICINE, PC

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

## Provider details

- **NPI number:** 1588983415
- **Authorized official:** DR. BHAVESH R PATEL M.D. (PHYSICIAN/OWNER)
- **Authorized official phone:** (203) 645-8859

## Contact information

- **Practice address:** 1579 STRAITS TPKE, TURNPIKE OFFICE PARK, MIDDLEBURY, CT 06762-1835
- **Practice address phone:** (203) 598-7246
- **Practice address fax:** (203) 598-0200
- **Mailing address:** 1579 STRAITS TPKE, TURNPIKE OFFICE PARK, MIDDLEBURY, CT 06762-1835
- **Mailing address phone:** (203) 598-7246
- **Mailing address fax:** (203) 598-0200

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 040593 | CT | Yes |
| 208VP0000X | Pain Medicine Physician | 040593 | CT | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LG0600X | Gerontology Nurse Practitioner | — | NULL | — |
| 363LG0600X | Gerontology Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 05/17/2010
- **Last updated:** 09/12/2024