Provider Demographics
NPI:1043652902
Name:COMPREHENSIVE SPINE AND PAIN MANAGEMENT
Entity type:Organization
Organization Name:COMPREHENSIVE SPINE AND PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ASIT
Authorized Official - Middle Name:PRAVIN
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-463-4704
Mailing Address - Street 1:PO BOX 5805
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-0805
Mailing Address - Country:US
Mailing Address - Phone:302-463-4704
Mailing Address - Fax:
Practice Address - Street 1:550 STANTON CHRISTIANA RD STE 303
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2125
Practice Address - Country:US
Practice Address - Phone:302-463-4704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-20
Last Update Date:2013-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006663261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain