Organization · NPI-2

125th Street Nm Corp

Clinic/Center, Pain · North Miami, FL

NPI number1578879375
StatusActive
Last updated in NPPESAug 31, 2010

Details

NPI
1578879375
Entity type
Organization (NPI-2)
Legal business name
125th Street Nm Corp
Organization subpart
No
Enumeration date
Aug 31, 2010
Last updated
Aug 31, 2010

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QP3300X Clinic/Center, PainPMC 20FLYes
261QP2000X Clinic/Center, Physical TherapyPMC 20FL

Other names

  • 125th Street Pain Clinic (Doing Business As)

Practice location

505 Ne 125th St
North Miami, FL 33161-4718

Phone 786-235-7240 · Fax 786-235-7241

Mailing address

505 Ne 125th St
North Miami, FL 33161-4718

Phone 786-235-7240 · Fax 786-235-7241

Authorized official

Igor Niznik
President
7862357240

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