Healthcare Provider Details

I. General information

NPI: 1508680034
Provider Name (Legal Business Name): HEADACHE INTERVENTION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 ASTORIA BLVD
ASTORIA NY
11103-3608
US

IV. Provider business mailing address

21 LODGE RD
GREAT NECK NY
11021-3927
US

V. Phone/Fax

Practice location:
  • Phone: 816-866-7246
  • Fax:
Mailing address:
  • Phone: 816-866-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FRED COHEN
Title or Position: PRESIDENT
Credential: MD
Phone: 816-866-7246