Provider Demographics
NPI:1528801024
Name:AVICENNA PAIN TREATMENT GROUP
Entity type:Organization
Organization Name:AVICENNA PAIN TREATMENT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHURAVKOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-906-9279
Mailing Address - Street 1:PO BOX 110055
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-0901
Mailing Address - Country:US
Mailing Address - Phone:862-333-8935
Mailing Address - Fax:201-983-6600
Practice Address - Street 1:152 POND DR
Practice Address - Street 2:
Practice Address - City:TOWNSHIP OF WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07676-5130
Practice Address - Country:US
Practice Address - Phone:862-333-8935
Practice Address - Fax:201-983-6600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty