Organization
125TH STREET NM CORP
Active
Other names
125th Street Pain Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IGOR NIZNIK (PRESIDENT)
(786) 235-7240
Entity
Organization
Contact information
Practice address
505 NE 125TH ST, NORTH MIAMI, FL 33161-4718
(786) 235-7240
(786) 235-7241
Mailing address
505 NE 125TH ST, NORTH MIAMI, FL 33161-4718
(786) 235-7240
(786) 235-7241
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
PMC 20
FL
261QP3300X
Pain Clinic/Center
Primary
PMC 20
FL
Other
Enumeration date
08/31/2010
Last updated
08/31/2010
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