Organization
125TH STREET NM CORP
Active
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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