Healthcare Provider Details

I. General information

NPI: 1194264044
Provider Name (Legal Business Name): RIBEIRO PAIN MANAGEMENT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3272 STEINWAY ST SUITE 503
ASTORIA NY
11103-4182
US

IV. Provider business mailing address

2303 31ST AVE APT 4B
ASTORIA NY
11106-4083
US

V. Phone/Fax

Practice location:
  • Phone: 347-229-3331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number240842
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SADY RIBEIRO
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 814-933-7672