Organization
INTERVENTIONAL PAIN SPINE & ORTHOPEDICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARISOL J REYES (RCM)
(973) 688-8543
Entity
Organization
Contact information
Practice address
185 KINGSLAND ST, NUTLEY, NJ 07110-1119
(973) 688-8543
Mailing address
185 KINGSLAND ST, NUTLEY, NJ 07110-1119
(973) 688-8543
(973) 200-8587
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207T00000X
Neurological Surgery Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003194812
NPI
—
01
—
1124102652
NPI
—
01
—
1124236229
NPI
—
01
—
1184832255
NPI
—
01
—
1306862248
NPI
—
01
—
1497870158
NPI
—
01
—
1780831404
NPI
—
01
—
1912349390
NPI
—
01
—
1992754634
NPI
—
Enumeration date
11/12/2021
Last updated
12/17/2021
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