Provider Demographics
NPI:1053363457
Name:FLORIDA PAIN AND REHABILITATION ASSOCIATES INC
Entity type:Organization
Organization Name:FLORIDA PAIN AND REHABILITATION ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-622-5766
Mailing Address - Street 1:5365 W ATLANTIC AVE
Mailing Address - Street 2:SUITE 504
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8172
Mailing Address - Country:US
Mailing Address - Phone:561-241-9300
Mailing Address - Fax:561-241-9339
Practice Address - Street 1:5365 W ATLANTIC AVE
Practice Address - Street 2:SUITE 504
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8172
Practice Address - Country:US
Practice Address - Phone:561-241-9300
Practice Address - Fax:561-241-9339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
FLME109651208VP0014X
FL800025838291U00000X
FLPH243723336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No3336C0002XSuppliersPharmacyClinic PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0149537-03Medicaid
FL0149537-00Medicaid
FL0149537-00Medicaid
FL0149537-00Medicaid
FL34259BMedicare PIN
FL011835804Medicaid
FL34259BMedicare PIN