| NPI | 1578879375 |
|---|---|
| Doing Business As | 125TH STREET PAIN CLINIC |
| Entity Type | Organization |
| Authorized Contact | IGOR NIZNIK President 786-235-7240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP3300X Clinic/Center, Pain (Licence: FL PMC 20) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: FL PMC 20) |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2010-08-31 |