Organization
INSTITUTE FOR DIAGNOSIS & TREATMENT OF PAIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARINA PRAKHINA (OFFICE MANAGER)
(201) 796-7666
Entity
Organization
Contact information
Practice address
33-00 BROADWAY, SUITE # 209, FAIR LAWN, NJ 07410-4617
(201) 796-7666
(201) 796-5570
Mailing address
33-00 BROADWAY, SUITE # 209, FAIR LAWN, NJ 07410-4617
(201) 796-7666
(201) 796-5570
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA068923
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7979100
—
NJ
Enumeration date
08/29/2006
Last updated
08/10/2012
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