Healthcare Provider Details

I. General information

NPI: 1083032916
Provider Name (Legal Business Name): NY PAIN PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4287 KATONAH AVE
BRONX NY
10470-2122
US

IV. Provider business mailing address

4287 KATONAH AVE
BRONX NY
10470-2122
US

V. Phone/Fax

Practice location:
  • Phone: 646-379-8940
  • Fax:
Mailing address:
  • Phone: 646-379-8940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number223679
License Number StateNY

VIII. Authorized Official

Name: ANGELA STROE
Title or Position: OFFICER
Credential: D.O.
Phone: 914-384-3746