Healthcare Provider Details

I. General information

NPI: 1497599930
Provider Name (Legal Business Name): DNA PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 88TH ST
BROOKLYN NY
11209-5665
US

IV. Provider business mailing address

380 88TH ST
BROOKLYN NY
11209-5665
US

V. Phone/Fax

Practice location:
  • Phone: 407-368-7946
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: OMAR DUQMAQ
Title or Position: OWNER
Credential:
Phone: 407-368-7946