Healthcare Provider Details

I. General information

NPI: 1003056367
Provider Name (Legal Business Name): ULTIMATE PAIN MANAGEMENT PHYSICIANS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 E 149TH ST SUITE 216
BRONX NY
10455-3907
US

IV. Provider business mailing address

391 E 149TH ST SUITE 216
BRONX NY
10455-3907
US

V. Phone/Fax

Practice location:
  • Phone: 718-292-7845
  • Fax: 718-292-7094
Mailing address:
  • Phone: 718-292-7845
  • Fax: 718-292-7094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number200019
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number200019
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number200019
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207LH0002X
TaxonomyHospice and Palliative Medicine (Anesthesiology) Physician
License Number200019
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number200019
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number200019
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number200019
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number200019
License Number StateNY

VIII. Authorized Official

Name: DR. DAVID MARSHAK
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 718-292-7845