Provider Demographics
NPI:1679992218
Name:FLORIDA PAIN & REHABILITATION INSTITUTE INC
Entity type:Organization
Organization Name:FLORIDA PAIN & REHABILITATION INSTITUTE 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 1:451 S MILWEE ST
Practice Address - Street 2:SUITE 1010
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4140
Practice Address - Country:US
Practice Address - Phone:407-622-7246
Practice Address - Fax:407-599-7246
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA PAIN AND REHABILITATION ASSOCIATES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-10
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109651207LP2900X, 2081P2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4273890011OtherMEDICARE DME
FL0149537-00Medicaid
FL34259AOtherMEDICARE
FL4273890011OtherMEDICARE DME
FL34259AOtherMEDICARE