Healthcare Provider Details

I. General information

NPI: 1780511964
Provider Name (Legal Business Name): SOUTHEAST PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 LINCOLN RD STE 6H-1479
MIAMI BEACH FL
33139-3020
US

IV. Provider business mailing address

4770 WHITE PLAINS RD
BRONX NY
10470-1136
US

V. Phone/Fax

Practice location:
  • Phone: 718-931-9700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL KOHN
Title or Position: MEMBER
Credential:
Phone: 718-931-9700