NPIMap

Organization Active NPI

Institute for Diagnosis & Treatment of Pain

  • Specialist
  • Fair Lawn, NJ
National Provider Identifier
1033227004
Registry record updated Aug 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
MA068923 Issued in NJ
Legal business name
INSTITUTE FOR DIAGNOSIS & TREATMENT OF PAIN
Practice address
33-00 Broadway
Suite # 209
Fair Lawn, NJ 07410-4617
Phone
(201) 796-7666
Fax
(201) 796-5570
NPI assigned
Aug 29, 2006
Last updated
Aug 10, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Marina Prakhina
Title
Office Manager
Phone
(201) 796-7666

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X MA068923 NJ Primary

Addresses

Primary practice location

33-00 Broadway
Suite # 209
Fair Lawn, NJ 07410-4617

Mailing address

33-00 Broadway
Suite # 209
Fair Lawn, NJ 07410-4617
Phone (201) 796-7666

Other identifiers 1

IdentifierTypeStateIssuer
7979100MedicaidNJ

National Provider Directory

National Provider Directory

Locations

33-00 Broadway
Ste 209
Fair Lawn, NJ 07410
Phone (201) 796-7666

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344556800000",
    "number": "1033227004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33-00 BROADWAY",
            "address_2": "SUITE # 209",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074104617",
            "telephone_number": "201-796-7666",
            "fax_number": "201-796-5570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33-00 BROADWAY",
            "address_2": "SUITE # 209",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074104617",
            "telephone_number": "201-796-7666",
            "fax_number": "201-796-5570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSTITUTE FOR DIAGNOSIS & TREATMENT OF PAIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2012-08-10",
        "status": "A",
        "authorized_official_last_name": "PRAKHINA",
        "authorized_official_first_name": "MARINA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "201-796-7666",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "MA068923",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7979100",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fair Lawn, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.