Tri State Spine and Pain Professional Corporation

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

Legal business name

TRI STATE SPINE AND PAIN PROFESSIONAL CORPORATION

Practice address

596 Anderson Ave Ste 216
Cliffside Park, NJ 07010-1856

Phone

(551) 277-2071

Fax

(561) 529-5144

NPI assigned

Mar 28, 2022

Organization subpart

No

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

Authorized official

Name

Mikhail Artamonov, MD

Title

Ceo

Phone

(570) 972-6778

Specialties & licenses 1

Addresses

Other names 1

• TRI STATE SPINE AND PAIN PROFESSIONAL CORPORATION Former legal business name

Locations

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

{
    "created_epoch": "1648425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648425600000",
    "number": "1144970419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "596 ANDERSON AVE STE 216",
            "city": "CLIFFSIDE PARK",
            "state": "NJ",
            "postal_code": "070101856",
            "telephone_number": "551-277-2071",
            "fax_number": "561-529-5144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "596 ANDERSON AVE STE 216",
            "city": "CLIFFSIDE PARK",
            "state": "NJ",
            "postal_code": "070101856",
            "telephone_number": "551-277-2071",
            "fax_number": "561-529-5144"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300A Princeton Hightstown Rd Ste 202",
            "address_purpose": "LOCATION",
            "city": "East Windsor",
            "state": "NJ",
            "postal_code": "085201421",
            "country_code": "US",
            "telephone_number": "561-277-2071",
            "fax_number": "561-277-5144",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TRI STATE SPINE AND PAIN PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-28",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A",
        "authorized_official_last_name": "ARTAMONOV",
        "authorized_official_first_name": "MIKHAIL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "570-972-6778",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TRI STATE SPINE AND PAIN PROFESSIONAL CORPORATION",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Cliffside Park, NJ
• Providers in Cliffside Park, NJ by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; 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.