# INTERVENTIONAL SPINE & SPORTS MEDICINE, PC

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

## Provider details

- **NPI number:** 1871805697
- **Authorized official:** BHAVESH R PATEL MD (PRESIDENT)
- **Authorized official phone:** (203) 645-8859

## Contact information

- **Practice address:** 935 RAINBOW TRL, ORANGE, CT 06477-1034
- **Practice address phone:** (203) 645-8859
- **Mailing address:** 935 RAINBOW TRL, ORANGE, CT 06477-1034
- **Mailing address phone:** (203) 645-8859

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 040593 | CT | Yes |

## Other

- **Enumeration date:** 07/09/2010
- **Last updated:** 07/09/2010